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General NPI Number Information
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NPI Number | 1225742026
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Entity Type | Organization
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Legal Business Name | DRAGONFLY MENTAL HEALTH PROFESSIONAL CLINICAL COUNSELORS, INC
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Dates
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Enumeration Date | 01/06/2023
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 15320 S WILTON PL
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City | GARDENA
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State | CA
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Zip | 90249-4247
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Country | US
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Telephone | 413-244-3832
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Fax |
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Provider Business Mailing Address
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Address Line | 15320 S WILTON PL
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City | GARDENA
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State | CA
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Zip | 90249-4247
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Country | US
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Telephone | 413-244-3832
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. ROBERT FEINER
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Credential | LPCC
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Telephone | 213-807-3358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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