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General NPI Number Information
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NPI Number | 1225257116
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Entity Type | Organization
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Legal Business Name | GUIDANCE HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 09/28/2007
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Provider Practice Location Address
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Address Line | 11633 HAWTHORNE BLVD STE 210
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City | HAWTHORNE
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State | CA
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Zip | 90250-2322
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Country | US
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Telephone | 310-978-0461
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Fax |
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Provider Business Mailing Address
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Address Line | 11633 HAWTHORNE BLVD STE 210
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City | HAWTHORNE
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State | CA
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Zip | 90250-2322
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Country | US
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Telephone | 310-978-0461
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. TEDDY IDEHEN
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Credential | BSC
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Telephone | 310-978-0461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6872
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License Number State | CA
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