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General NPI Number Information
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NPI Number | 1386047124
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Entity Type | Organization
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Legal Business Name | LEADING EDGE TRANSITIONS
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 10/08/2014
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Provider Practice Location Address
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Address Line | 155 GRANADA ST SUITE A
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City | CAMARILLO
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State | CA
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Zip | 93010-7866
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Country | US
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Telephone | 805-340-8055
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Fax |
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Provider Business Mailing Address
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Address Line | 9050 FEATHER ST
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City | VENTURA
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State | CA
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Zip | 93004-3046
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Country | US
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Telephone | 805-340-8055
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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. TED WRABLIK
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Credential | MFT
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Telephone | 805-340-8055
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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 | LMFT49057
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License Number State | CA
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