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General NPI Number Information
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NPI Number | 1245947696
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Entity Type | Organization
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Legal Business Name | EGS LICENSED CLINICAL SOCIAL WORKER PC
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Dates
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Enumeration Date | 11/03/2022
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 4605 BUENA VISTA ROAD STE 600 #714
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City | BAKERSFIELD
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State | CA
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Zip | 93311
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Country | US
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Telephone | 661-390-9188
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Fax |
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Provider Business Mailing Address
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Address Line | 2108 N ST STE N
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City | SACRAMENTO
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State | CA
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Zip | 95816-5712
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Country | US
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Telephone | 661-390-9188
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERIN GISH-STILES
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Credential | LCSW
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Telephone | 661-390-9188
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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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