Provider Demographics
NPI:1336664317
Name:PARK, JU HEA (ACSW)
Entity Type:Individual
Prefix:
First Name:JU HEA
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 ST PAUL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-5660
Mailing Address - Country:US
Mailing Address - Phone:213-483-3000
Mailing Address - Fax:213-483-6529
Practice Address - Street 1:600 ST PAUL AVE STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-5660
Practice Address - Country:US
Practice Address - Phone:213-483-3000
Practice Address - Fax:213-483-6529
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA390200000X
CA95280101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program