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General NPI Number Information
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NPI Number | 1982433801
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Entity Type | Organization
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Legal Business Name | THERESA GOLDSTEIN, PROFESSIONAL CLINICAL COUSNELOR, P.C.
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Dates
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Enumeration Date | 07/30/2024
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 2615 PCH HWY STE 325
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-2236
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Country | US
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Telephone | 818-806-8767
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Fax |
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Provider Business Mailing Address
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Address Line | 2615 PCH HWY STE 325
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-2236
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Country | US
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Telephone | 818-806-8767
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Fax |
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Authorized Official
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Title or Position | CEO, OWNER, SECRETARY, TREASURER
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Name | THERESA GOLDSTEIN
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Credential | MA, LPCC
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Telephone | 818-806-8767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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