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General NPI Number Information
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NPI Number | 1821878075
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Entity Type | Organization
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Legal Business Name | SUPPORT PATH THERAPY
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Dates
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Enumeration Date | 10/04/2023
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 1359 SONORA AVE
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City | GLENDALE
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State | CA
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Zip | 91201-1411
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Country | US
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Telephone | 909-263-4307
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5794 6444 SAN FERNANDO ROAD
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City | GLENDALE
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State | CA
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Zip | 91201
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Country | US
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Telephone | 747-272-9983
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | VALERIE ANNE ORTEGA
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Credential | LCSW
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Telephone | 747-272-9983
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 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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