MEDICARE: TEENS HAPPY HOME, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YP1600X	Pastoral Counselor
4	101YP2500X	Professional Counselor
5	103K00000X	Behavior Analyst
6	103TE1100X	Exercise & Sports Psychologist
7	103TF0000X	Family Psychologist
8	104100000X	Social Worker
9	1041S0200X	School Social Worker
10	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1659715167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEENS HAPPY HOME, INC.

Provider Business Mailing Address
First Line	:	6801 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-1840
Country	:	US
Telephone Number	:	323-971-9050
Fax Number	:	323-971-9045

Provider Business Practice Location Address
First Line	:	6801 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-1840
Country	:	US
Telephone Number	:	323-971-9050
Fax Number	:	323-971-9045

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	BEAUTINA ROBINSON
Credential	:
Telephone Number	:	323-971-9050

Provider Enumeration Date	:	04/26/2013
Last Update Date	:	04/26/2013

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Directions to “TEENS HAPPY HOME, INC. ” Practice Location

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