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General NPI Number Information
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NPI Number | 1346949815
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Entity Type | Organization
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Legal Business Name | RESET SUMMER CAMP
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Dates
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Enumeration Date | 02/23/2023
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 955 LA PAZ RD
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City | SANTA BARBARA
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State | CA
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Zip | 93108-1023
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Country | US
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Telephone | 909-973-4792
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Fax |
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Provider Business Mailing Address
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Address Line | 13100 VALLEYHEART DR APT 206
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City | STUDIO CITY
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State | CA
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Zip | 91604-1927
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Country | US
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Telephone | 909-973-4792
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. SHELLY GUTENSOHN
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Credential | LMFT
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Telephone | 909-973-4792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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