Provider Demographics
NPI:1093161218
Name:TONYA M. JAVADI, INC
Entity Type:Organization
Organization Name:TONYA M. JAVADI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-819-7332
Mailing Address - Street 1:114 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3841
Mailing Address - Country:US
Mailing Address - Phone:310-819-7332
Mailing Address - Fax:
Practice Address - Street 1:114 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3841
Practice Address - Country:US
Practice Address - Phone:310-819-7332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW54701041C0700X
CAMFT40403106H00000X
CAMFT37168106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty