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General NPI Number Information
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NPI Number | 1316191588
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Entity Type | Individual
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Provider Name | JOHN KENNETH PROCTOR MSW
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Gender | Male
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Dates
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Enumeration Date | 11/13/2008
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 6519 8TH AVE
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City | LOS ANGELES
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State | CA
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Zip | 90043-4313
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Country | US
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Telephone | 323-750-5167
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Fax | 323-759-2697
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Provider Business Mailing Address
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Address Line | 3437 W 82ND PL
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City | INGLEWOOD
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State | CA
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Zip | 90305-1602
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Country | US
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Telephone | 323-971-0877
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Fax | 323-759-2697
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 16760
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License Number State | CA
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