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General NPI Number Information
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NPI Number | 1538225982
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Entity Type | Organization
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Legal Business Name | SHILOH COMMUNITY COUNSELING & OUTREACH CENTER
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 08/29/2016
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Provider Practice Location Address
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Address Line | 101 S KRAEMER BLVD
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City | PLACENTIA
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State | CA
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Zip | 92870-6105
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Country | US
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Telephone | 714-223-1601
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Fax | 714-223-1601
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Provider Business Mailing Address
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Address Line | 101 S KRAEMER BLVD
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City | PLACENTIA
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State | CA
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Zip | 92870-6105
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Country | US
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Telephone | 714-223-1601
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Fax | 714-223-1601
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Authorized Official
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Title or Position | EXECUTIVE MANAGER
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Name | MRS. TANYA MC PETERS
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Credential |
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Telephone | 714-223-1601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT39418
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License Number State | CA
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