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General NPI Number Information
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NPI Number | 1265011803
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Entity Type | Organization
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Legal Business Name | BALLAN COUNSELING A LICENSED CLINICAL SOCIAL WORKER CORPORATION
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | 11911 186TH ST
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City | ARTESIA
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State | CA
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Zip | 90701
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Country | US
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Telephone | 562-384-4080
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Fax |
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Provider Business Mailing Address
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Address Line | 13337 SOUTH ST STE 16
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City | CERRITOS
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State | CA
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Zip | 90703-7308
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Country | US
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Telephone | 562-384-4080
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ALEX BALLAN
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Credential | LCSW
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Telephone | 562-384-4080
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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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