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General NPI Number Information
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NPI Number | 1396601167
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Entity Type | Organization
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Legal Business Name | ENVISION YOUTH SERVICES, INC.
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Dates
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Enumeration Date | 12/24/2025
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Last Update Date | 12/24/2025
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Provider Practice Location Address
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Address Line | 5378 LONG BEACH BLVD STE 136
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City | LONG BEACH
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State | CA
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Zip | 90805-5858
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Country | US
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Telephone | 562-519-9657
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Fax | 562-519-9657
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Provider Business Mailing Address
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Address Line | 5378 LONG BEACH BLVD STE 136
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City | LONG BEACH
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State | CA
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Zip | 90805-5858
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Country | US
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Telephone | 562-519-9657
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Fax | 562-519-9657
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KAMELAH THOMPSON
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Credential |
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Telephone | 562-519-9657
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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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