Provider Demographics
NPI:1275392185
Name:NGL THERAPY, LICENSED CLINICAL SOCIAL WORKER, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:NGL THERAPY, LICENSED CLINICAL SOCIAL WORKER, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEVINE-KAPKE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:805-225-4493
Mailing Address - Street 1:3019 E AVENIDA DE LOS ARBOLES
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4925
Mailing Address - Country:US
Mailing Address - Phone:805-225-4493
Mailing Address - Fax:
Practice Address - Street 1:3019 E AVENIDA DE LOS ARBOLES
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-4925
Practice Address - Country:US
Practice Address - Phone:805-225-4493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health