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General NPI Number Information
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NPI Number | 1104941442
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Entity Type | Organization
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Legal Business Name | ETTIE LEE YOUTH AND FAMILY SERVICES
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 12345 CHANDLER BLVD
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91607-2079
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Country | US
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Telephone | 818-760-0665
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Fax | 818-760-0157
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Provider Business Mailing Address
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Address Line | 10621 VALLEY SPRING LN #305
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City | TOLUCA LAKE
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State | CA
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Zip | 91602-3200
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Country | US
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Telephone | 818-760-9548
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Fax |
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Authorized Official
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Title or Position | THERAPEUTIC SOCIAL WORKER
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Name | MS. LEANE CATHERINE SHILLING
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Credential | M.S., IMF
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Telephone | 818-915-5497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | #50219
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License Number State | CA
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