=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215407341
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDUCATIONAL PSYCHOLOGY & FAMILY COUNSELING CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2018
-----------------------------------------------------
Last Update Date | 05/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 N GRAND AVE APT 258
-----------------------------------------------------
City | WEST COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91791-1748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-634-4783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 950446
-----------------------------------------------------
City | MISSION HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91395-0446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-634-4783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | DR. JOSE JAVIER JUAREZ
-----------------------------------------------------
Credential | PSYD., LMFT, LEP
-----------------------------------------------------
Telephone | 818-634-4783
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------