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NPI Code Detail

MEDICARE: JULIA-ELISE CHILDS THERAPY: A LICENSED CLINICAL SOCIAL WORKER CORP.

MEDICARE: JULIA-ELISE CHILDS THERAPY: A LICENSED CLINICAL SOCIAL WORKER CORP.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1043086945
Entity Type Code : Organization
Provider Name (Legal Business Name) : JULIA-ELISE CHILDS THERAPY: A LICENSED CLINICAL SOCIAL WORKER CORP.
Provider Business Mailing Address
First Line : 281 E COLORADO BLVD # 2395
Second Line :
City : PASADENA
State : CA
Zip : 91101-1903
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 200 E DEL MAR BLVD STE 160
Second Line :
City : PASADENA
State : CA
Zip : 91105-2507
Country : US
Telephone Number : 626-765-5308
Fax Number :
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MRS. JULIA-ELISE W CHILDS
Credential : LCSW
Telephone Number : 626-765-5308
Provider Enumeration Date : 11/30/2023
Last Update Date : 11/30/2023

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Directions to “JULIA-ELISE CHILDS THERAPY: A LICENSED CLINICAL SOCIAL WORKER CORP. ” Practice Location

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