MEDICARE: SPIRITUS THERAPY, A LICENSED CLINICAL SOCIAL WORK PROFESSIONAL CORPORATION

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1962365932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPIRITUS THERAPY, A LICENSED CLINICAL SOCIAL WORK PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	2355 WESTWOOD BLVD # 1128
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11221 RICHLAND AVE APT 104
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3950
Country	:	US
Telephone Number	:	310-363-0772
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STELLA DENNETT
Credential	:	LCSW, PHD
Telephone Number	:	310-800-4510

Provider Enumeration Date	:	12/06/2025
Last Update Date	:	12/10/2025

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