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General NPI Number Information
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NPI Number | 1861724296
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Entity Type | Organization
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Legal Business Name | WHEEL OF WELLBEING
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 1575 WESTWOOD BLVD 205
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City | LOS ANGELES
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State | CA
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Zip | 90024-5620
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Country | US
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Telephone | 310-477-8833
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Fax |
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Provider Business Mailing Address
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Address Line | 1575 WESTWOOD BLVD 205
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City | LOS ANGELES
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State | CA
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Zip | 90024-5620
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Country | US
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Telephone | 310-477-8833
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LARRY SHAW
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Credential | MFC
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Telephone | 310-477-8833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC17578
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License Number State | CA
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