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General NPI Number Information
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NPI Number | 1710345715
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Entity Type | Organization
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Legal Business Name | AIRPORT MARINA COUNSELING SERVICE
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 7891 LA TIJERA BLVD NONE
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City | LOS ANGELES
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State | CA
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Zip | 90045-3145
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Country | US
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Telephone | 310-670-1410
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Fax | 310-670-0919
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Provider Business Mailing Address
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Address Line | 7891 LA TIJERA BLVD NONE
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City | LOS ANGELES
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State | CA
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Zip | 90045-3145
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Country | US
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Telephone | 310-670-1410
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Fax | 310-670-0919
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Authorized Official
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Title or Position | EXECTUTIVE DIRECTOR
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Name | EDEN GARCIA-BALIS
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Credential | LMFT
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Telephone | 310-670-1410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 960000174
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License Number State | CA
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