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General NPI Number Information
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NPI Number | 1144461690
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Entity Type | Organization
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Legal Business Name | BROAD HORIZONS COUNSELING COLLECTIVE
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 5923 KANAN RD
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City | AGOURA HILLS
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State | CA
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Zip | 91301-1688
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Country | US
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Telephone | 310-866-2606
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Fax | 310-455-1416
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Provider Business Mailing Address
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Address Line | PO BOX 1410
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City | TOPANGA
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State | CA
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Zip | 90290-1410
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Country | US
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Telephone | 310-866-2606
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Fax | 310-455-1416
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Authorized Official
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Title or Position | CFO
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Name | VERONICA SHEFTZ WINSTON
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Credential |
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Telephone | 310-866-2606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY14856
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC42941
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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