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General NPI Number Information
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NPI Number | 1023731718
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Entity Type | Organization
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Legal Business Name | NLV PSYCHOTHERAPY & CONSULTING
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 250 S HARBOR BLVD
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City | SAN PEDRO
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State | CA
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Zip | 90731-2830
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Country | US
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Telephone | 714-606-8483
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Fax |
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Provider Business Mailing Address
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Address Line | 6143 NEVADA AVE
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City | SOUTH GATE
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State | CA
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Zip | 90280-8231
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Country | US
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Telephone | 714-606-8483
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | ADAM CASTILLO
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Credential | LCSW
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Telephone | 714-606-8483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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