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NPI Code Detail

MEDICARE: AIRPORT MARINA COUNSELING SERVICE

MEDICARE: AIRPORT MARINA COUNSELING SERVICE
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
1101YM0800XMental Health Counselor960000174CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1960000174OTHERCASTATE OF CALIFORNIA DEPARTMENT OF PUBLIC HEALTH

General Provider Information

NPI Number : 1710345715
Entity Type Code : Organization
Provider Name (Legal Business Name) : AIRPORT MARINA COUNSELING SERVICE
Provider Business Mailing Address
First Line : 7891 LA TIJERA BLVD
Second Line : NONE
City : LOS ANGELES
State : CA
Zip : 90045-3145
Country : US
Telephone Number : 310-670-1410
Fax Number : 310-670-0919
Provider Business Practice Location Address
First Line : 7891 LA TIJERA BLVD
Second Line : NONE
City : LOS ANGELES
State : CA
Zip : 90045-3145
Country : US
Telephone Number : 310-670-1410
Fax Number : 310-670-0919
Authorized Official
Title or Position : EXECTUTIVE DIRECTOR
Name : EDEN GARCIA-BALIS
Credential : LMFT
Telephone Number : 310-670-1410
Provider Enumeration Date : 02/04/2016
Last Update Date : 02/04/2016

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Directions to “AIRPORT MARINA COUNSELING SERVICE ” Practice Location

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