=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528489051
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MULTICULTURAL COUNSELING AND EMPOWERMENT CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2013
-----------------------------------------------------
Last Update Date | 12/31/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4726 BRYNHURST AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90043-1222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-292-4335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17215 STUDEBAKER RD SUITE 180
-----------------------------------------------------
City | CERRITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90703-2548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-292-4335
-----------------------------------------------------
Fax | 562-809-8620
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | MS. RENEE D WILLIAMS
-----------------------------------------------------
Credential | M.A.
-----------------------------------------------------
Telephone | 310-292-4335
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 45293
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------