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General NPI Number Information
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NPI Number | 1528625662
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Entity Type | Organization
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Legal Business Name | ORIGINS TREATMENT CENTER, LLC
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 09/17/2020
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Provider Practice Location Address
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Address Line | 5300 BEETHOVEN ST
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City | LOS ANGELES
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State | CA
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Zip | 90066-7069
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Country | US
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Telephone | 310-927-7532
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Fax |
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Provider Business Mailing Address
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Address Line | 5300 BEETHOVEN ST
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City | LOS ANGELES
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State | CA
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Zip | 90066-7069
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MR. GARRETT STANFORD
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Credential |
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Telephone | 626-590-0772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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