MEDICARE: INTERFACE CHILDREN FAMILY SERVICES

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
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1497961684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERFACE CHILDREN FAMILY SERVICES

Provider Business Mailing Address
First Line	:	4001 MISSION OAKS BLVD.
Second Line	:	SUITE I
City	:	CAMARILLO
State	:	CA
Zip	:	93012-5121
Country	:	US
Telephone Number	:	805-485-6114
Fax Number	:	805-983-0789

Provider Business Practice Location Address
First Line	:	4001 MISSION OAKS BLVD.
Second Line	:	SUITE I
City	:	CAMARILLO
State	:	CA
Zip	:	93012-5121
Country	:	US
Telephone Number	:	805-485-6114
Fax Number	:	805-983-0789

Authorized Official
Title or Position	:	MENTAL HEALTH DIRECTOR
Name	:	JOELLE VESSELS
Credential	:	LMFT
Telephone Number	:	805-485-6114

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	03/17/2016

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1902000367 — MS. VIRGINIA TAPANES CHOUNET LCSW
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