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General NPI Number Information
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NPI Number | 1861026445
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Entity Type | Organization
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Legal Business Name | PERSONALIZED TREATMENT & INTERVENTION SERVICES
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Dates
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Enumeration Date | 02/23/2020
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 519 E HAZEL ST UNIT 17
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City | INGLEWOOD
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State | CA
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Zip | 90302-5358
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Country | US
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Telephone | 916-904-4607
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Fax |
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Provider Business Mailing Address
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Address Line | 519 E HAZEL ST UNIT 17
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City | INGLEWOOD
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State | CA
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Zip | 90302-5358
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Country | US
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Telephone | 916-904-4607
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | EARNESTINE WHITSON
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Credential |
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Telephone | 323-379-5003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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