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General NPI Number Information
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NPI Number | 1225506983
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Entity Type | Organization
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Legal Business Name | MIDWEST COUNSELING AND FAMILY SERVICES INC.
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Dates
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Enumeration Date | 11/10/2018
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Last Update Date | 11/10/2018
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Provider Practice Location Address
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Address Line | 448 E FOOTHILL BLVD STE 210
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City | SAN DIMAS
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State | CA
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Zip | 91773-1221
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Country | US
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Telephone | 951-364-4775
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Fax |
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Provider Business Mailing Address
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Address Line | 8605 SANTA MONICA BLVD # 98038
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-4109
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Country | US
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Telephone | 951-364-4775
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MISS KENDRA THEROITH
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Credential | LMFT
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Telephone | 951-364-4775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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