Provider Demographics
NPI:1225742026
Name:DRAGONFLY MENTAL HEALTH PROFESSIONAL CLINICAL COUNSELORS, INC
Entity Type:Organization
Organization Name:DRAGONFLY MENTAL HEALTH PROFESSIONAL CLINICAL COUNSELORS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FEINER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:213-807-3358
Mailing Address - Street 1:15320 S WILTON PL
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-4247
Mailing Address - Country:US
Mailing Address - Phone:413-244-3832
Mailing Address - Fax:
Practice Address - Street 1:15320 S WILTON PL
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4247
Practice Address - Country:US
Practice Address - Phone:413-244-3832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-06
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty