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General NPI Number Information
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NPI Number | 1952438046
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Entity Type | Organization
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Legal Business Name | THE SEXUAL RECOVERY INSTITUTE
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 822 S ROBERTSON BLVD STE 303
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City | LOS ANGELES
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State | CA
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Zip | 90035-1632
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Country | US
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Telephone | 310-360-0130
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Fax | 310-360-0133
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Provider Business Mailing Address
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Address Line | 822 S ROBERTSON BLVD STE 303
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City | LOS ANGELES
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State | CA
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Zip | 90035-1632
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Country | US
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Telephone | 310-360-0130
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Fax | 310-360-0133
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Authorized Official
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Title or Position | ADMINSTRATIVE DIRECTOR
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Name | MS. CECILIA QUIGLEY
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Credential | M.A.
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Telephone | 310-360-0130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS17670
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License Number State | CO
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