MEDICARE: CHILDREN'S MENTAL HEALTH DIAGNOSTIC AND TREATMENT SERVICES OF VEN CO

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	:	1780838029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S MENTAL HEALTH DIAGNOSTIC AND TREATMENT SERVICES OF VEN CO

Provider Business Mailing Address
First Line	:	2828 COCHRAN ST # 223
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-2780
Country	:	US
Telephone Number	:	805-657-9990
Fax Number	:

Provider Business Practice Location Address
First Line	:	1459 E THOUSAND OAKS BLVD
Second Line	:	SUITE # H1
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91362-2806
Country	:	US
Telephone Number	:	805-657-9990
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CYNTHIA PINZON TORRES
Credential	:	M.S., MFT
Telephone Number	:	805-657-9990

Provider Enumeration Date	:	11/13/2008
Last Update Date	:	10/04/2016

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