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General NPI Number Information
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NPI Number | 1144972654
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Entity Type | Organization
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Legal Business Name | SUPPORTIVE SERVICES BY HOUSEAL, LICENSED CLINICAL SOCIAL WORKER INC.
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 03/24/2023
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Provider Practice Location Address
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Address Line | 1050 LAKES DR STE 225
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City | WEST COVINA
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State | CA
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Zip | 91790-2910
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Country | US
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Telephone | 626-699-0990
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 LAKES DR STE 225
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City | WEST COVINA
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State | CA
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Zip | 91790-2910
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Country | US
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Telephone | 626-699-0990
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Fax |
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Authorized Official
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Title or Position | CEO AND PRESIDENT- LCSW
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Name | MR. RICHARD EDDIE HOUSEAL JR.
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Credential | LCSW
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Telephone | 302-668-6525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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