Provider Demographics
NPI:1285007583
Name:COUNSELING & BEHAVIORAL SPECIALISTS
Entity Type:Organization
Organization Name:COUNSELING & BEHAVIORAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT
Authorized Official - Phone:619-697-0470
Mailing Address - Street 1:5520 WELLESLEY STREET
Mailing Address - Street 2:STE 204
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-697-0470
Mailing Address - Fax:619-697-0505
Practice Address - Street 1:5520 WELLESLEY STREET
Practice Address - Street 2:STE 204
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-697-0470
Practice Address - Fax:619-697-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF86745106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty