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General NPI Number Information
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NPI Number | 1760923320
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Entity Type | Organization
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Legal Business Name | MEDIATION - COUNSELING
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 03/16/2017
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Provider Practice Location Address
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Address Line | 21515 HAWTHORNE BLVD SUITE 1025
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City | TORRANCE
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State | CA
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Zip | 90503-6501
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Country | US
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Telephone | 310-540-9128
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Fax |
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Provider Business Mailing Address
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Address Line | 21515 HAWTHORNE BLVD SUITE 1025
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City | TORRANCE
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State | CA
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Zip | 90503-6501
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Country | US
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Telephone | 310-540-9128
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID KENICHI KURODA
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Credential | LCSW
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Telephone | 310-540-9128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LCSW5131
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License Number State | CA
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