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General NPI Number Information
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NPI Number | 1104204460
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Entity Type | Organization
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Legal Business Name | LIFTED TOGETHER INC LICENSED CLINICAL SOCIAL WORKER
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 05/07/2015
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Provider Practice Location Address
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Address Line | 8363 RESEDA BLVD SUITE 203E
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City | NORTHRIDGE
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State | CA
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Zip | 91324-4623
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Country | US
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Telephone | 818-727-7742
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Fax |
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Provider Business Mailing Address
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Address Line | 8363 RESEDA BLVD SUITE 203E
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City | NORTHRIDGE
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State | CA
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Zip | 91324-4623
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Country | US
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Telephone | 818-727-7742
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER/ MANAGER
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Name | MRS. TANYATTA CHATEAU
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Credential | LCSW
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Telephone | 818-606-9836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LCS 23309
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | LCS 23309
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License Number State | CA
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