=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467073965
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLOWLAB INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2020
-----------------------------------------------------
Last Update Date | 05/06/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4528 LOS FELIZ BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90027-2006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-275-7775
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4528 LOS FELIZ BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90027-2006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-275-7775
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. WILLIAM HOWARD FORT JR.
-----------------------------------------------------
Credential | CCHT
-----------------------------------------------------
Telephone | 855-275-7775
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------