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General NPI Number Information
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NPI Number | 1558390641
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Entity Type | Organization
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Legal Business Name | THE GREENLEAF CENTER A PSYCHOLOGICAL SERVICES CORPORATION
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 04/06/2015
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Provider Practice Location Address
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Address Line | 13006 PHILADELPHIA ST SUITE 411
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City | WHITTIER
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State | CA
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Zip | 90601-4210
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Country | US
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Telephone | 562-945-5108
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Fax | 562-945-5208
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Provider Business Mailing Address
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Address Line | 13006 PHILADELPHIA ST SUITE 411
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City | WHITTIER
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State | CA
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Zip | 90601-4210
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Country | US
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Telephone | 562-945-5108
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Fax | 562-945-5208
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JORGE GARCIA
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Credential | PH.D.
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Telephone | 562-945-5108
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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 | MFC41879
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY16485
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License Number State | CA
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