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General NPI Number Information
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NPI Number | 1346455466
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Entity Type | Organization
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Legal Business Name | SOCIAL MODEL RECOVERY SYSTEMS INC
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 510 S 2ND AVE STE 6AND7
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City | COVINA
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State | CA
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Zip | 91723-3017
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Country | US
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Telephone | 626-974-8123
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Fax | 626-974-8198
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Provider Business Mailing Address
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Address Line | 510 S 2ND AVE STE 6AND7
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City | COVINA
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State | CA
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Zip | 91723-3017
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Country | US
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Telephone | 626-974-8122
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Fax | 626-966-2799
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Authorized Official
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Title or Position | SENIOR DIRECTOR OF CLINICAL SERVICE
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Name | LYNETTA HALE
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Credential | AMFT, LPT, MA
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Telephone | 626-332-3145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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