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General NPI Number Information
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NPI Number | 1386292951
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Entity Type | Organization
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Legal Business Name | BUILDING LASTING SUCCESS TOGETHER A PROFESSIONAL PSYCHOTHERAPY CORPORA
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Dates
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Enumeration Date | 08/27/2019
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 2512 FOOTHILL BLVD
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City | LA CRESCENTA
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State | CA
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Zip | 91214-3506
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Country | US
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Telephone | 818-583-7134
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Fax |
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Provider Business Mailing Address
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Address Line | 2512 FOOTHILL BLVD
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City | LA CRESCENTA
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State | CA
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Zip | 91214-3506
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHERINE ENNEY
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Credential | PSYD
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Telephone | 818-583-7134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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