=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417186701
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHY INDIVIDUALS AND FAMILY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2009
-----------------------------------------------------
Last Update Date | 07/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12440 FIRESTONE BLVD SUITE 116
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90650-4328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-946-8096
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12440 FIRESTONE BLVD SUITE 116
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90650-4328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-946-8096
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MENTAL HEALTH THERAPIST INTERN
-----------------------------------------------------
Name | MS. SALMA THEUS
-----------------------------------------------------
Credential | MS MFT
-----------------------------------------------------
Telephone | 310-946-8096
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | 59562
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------