Provider Demographics
NPI:1235268194
Name:COMMUNITY COUNSELING FOR INDIVIDUALS AND FAMILIES
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING FOR INDIVIDUALS AND FAMILIES
Other - Org Name:EATING DISORDER CENTER OF CA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:RADANT
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:310-472-3728
Mailing Address - Street 1:27162 SEA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4437
Mailing Address - Country:US
Mailing Address - Phone:310-457-9958
Mailing Address - Fax:310-457-8442
Practice Address - Street 1:520 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-3521
Practice Address - Country:US
Practice Address - Phone:310-472-3728
Practice Address - Fax:310-472-9960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13192261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)