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General NPI Number Information
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NPI Number | 1386450690
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Entity Type | Organization
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Legal Business Name | ST. ANNE'S
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 155 N OCCIDENTAL BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90026-4641
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Country | US
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Telephone | 213-812-9313
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Fax |
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Provider Business Mailing Address
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Address Line | 155 N OCCIDENTAL BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90026-4641
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Country | US
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Telephone | 213-760-6987
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Fax |
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Authorized Official
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Title or Position | CLINICAL AND ADMINISTRATIVE SITE SU
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Name | JACPUELINE ZAVALA
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Credential | LCSW
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Telephone | 323-381-2931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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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 | 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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