=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518086834
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MULTICULTURAL COUNSELING SERVICE CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9800 S LA CIENEGA BLVD STE. 310
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90301-4440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-410-9301
-----------------------------------------------------
Fax | 310-410-1259
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9800 S LA CIENEGA BLVD STE. 310
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90301-4440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-410-9301
-----------------------------------------------------
Fax | 310-410-1259
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. ERNEST V. NUNEZ
-----------------------------------------------------
Credential | PSY.D., LCSW
-----------------------------------------------------
Telephone | 310-410-9301
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 13420
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------