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General NPI Number Information
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NPI Number | 1275392185
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Entity Type | Organization
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Legal Business Name | NGL THERAPY, LICENSED CLINICAL SOCIAL WORKER, PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/14/2024
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Last Update Date | 04/12/2024
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Provider Practice Location Address
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Address Line | 3019 E AVENIDA DE LOS ARBOLES
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City | THOUSAND OAKS
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State | CA
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Zip | 91362-4925
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Country | US
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Telephone | 805-225-4493
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Fax |
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Provider Business Mailing Address
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Address Line | 3019 E AVENIDA DE LOS ARBOLES
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City | THOUSAND OAKS
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State | CA
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Zip | 91362-4925
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Country | US
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Telephone | 805-225-4493
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Fax |
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Authorized Official
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Title or Position | FOUNDER, THERAPIST
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Name | NICOLE G LEVINE-KAPKE
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Credential | MSW, LCSW
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Telephone | 805-225-4493
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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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