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General NPI Number Information
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NPI Number | 1669773313
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Entity Type | Organization
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Legal Business Name | IN-HOME THERAPEUTIC SERVICES OF SLO
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Dates
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Enumeration Date | 11/11/2010
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 1788 DONNA AVE
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City | LOS OSOS
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State | CA
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Zip | 93402-2014
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Country | US
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Telephone | 805-441-8843
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Fax | 805-528-6401
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Provider Business Mailing Address
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Address Line | PO BOX 6477
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City | LOS OSOS
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State | CA
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Zip | 93412-6477
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Country | US
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Telephone | 805-441-8843
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Fax | 805-528-6401
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ARTHUR WAYNE FREDERICK
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Credential | LCSW,ACSW,DCSW
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Telephone | 805-441-8843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LCS10732
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License Number State | CA
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