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General NPI Number Information
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NPI Number | 1114686839
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC SERVICES HEALING AND GROWTH INC
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Dates
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Enumeration Date | 12/09/2021
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 330 N MACLAY AVE STE 206
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City | SAN FERNANDO
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State | CA
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Zip | 91340-2955
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Country | US
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Telephone | 818-351-6717
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Fax |
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Provider Business Mailing Address
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Address Line | 330 N MACLAY AVE STE 206
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City | SAN FERNANDO
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State | CA
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Zip | 91340-2955
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Country | US
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Telephone | 818-351-6717
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GENESIS ESPINOZA
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Credential |
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Telephone | 818-472-7020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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