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General NPI Number Information
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NPI Number | 1659132520
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Entity Type | Organization
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Legal Business Name | JUSTYNS CORNER CHILD AND FAMILY COUNSELING CENTER, INC.
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Dates
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Enumeration Date | 01/18/2024
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 6080 CENTER DR FL 6
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City | LOS ANGELES
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State | CA
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Zip | 90045-9205
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Country | US
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Telephone | 310-735-2245
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Fax |
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Provider Business Mailing Address
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Address Line | 1123 E 126TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90059-3217
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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 | OWNER
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Name | IYASHEMA REDD
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Credential | LMFT
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Telephone | 310-735-2245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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