=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104641828
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYE OF THE STORM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2024
-----------------------------------------------------
Last Update Date | 11/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 W FOOTHILL BLVD
-----------------------------------------------------
City | MONROVIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91016-1913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-321-8141
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 W FOOTHILL BLVD
-----------------------------------------------------
City | MONROVIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91016-1913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-321-8141
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. ALMOG SHANUN
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 626-321-8141
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------