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NPI Code Detail

MEDICARE: EMILY DILLON, LICENSED CLINICAL SOCIAL WORKER, WILDFLOWER MENTAL HEALT

MEDICARE: EMILY DILLON, LICENSED CLINICAL SOCIAL WORKER, WILDFLOWER MENTAL HEALT
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
1261QM0850XAdult Mental Health Clinic/Center
2261QM0855XAdolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number : 1578263653
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMILY DILLON, LICENSED CLINICAL SOCIAL WORKER, WILDFLOWER MENTAL HEALT
Provider Business Mailing Address
First Line : 17020 CHATSWORTH ST # 1059
Second Line :
City : GRANADA HILLS
State : CA
Zip : 91344-5844
Country : US
Telephone Number : 818-213-1212
Fax Number :
Provider Business Practice Location Address
First Line : 17020 CHATSWORTH ST # 1059
Second Line :
City : GRANADA HILLS
State : CA
Zip : 91344-5844
Country : US
Telephone Number : 818-213-1212
Fax Number :
Authorized Official
Title or Position : PRESIDENT/CEO
Name : EMILY DILLON
Credential : LCSW, PPSC
Telephone Number : 818-454-3396
Provider Enumeration Date : 03/07/2023
Last Update Date : 03/07/2023

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