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General NPI Number Information
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NPI Number | 1720315948
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Entity Type | Organization
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Legal Business Name | UCLA TIES FOR FAMILIES
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Dates
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Enumeration Date | 11/09/2009
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Last Update Date | 10/16/2014
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Provider Practice Location Address
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Address Line | 1033 GAYLEY AVE SUITE 204
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City | LOS ANGELES
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State | CA
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Zip | 90024-3417
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Country | US
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Telephone | 310-794-2457
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 VETERAN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90024-2704
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Country | US
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Telephone | 310-794-2457
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | AUDRA LANGLEY
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Credential | PH.D
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Telephone | 310-794-2457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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