Provider Demographics
NPI:1346949815
Name:RESET SUMMER CAMP
Entity Type:Organization
Organization Name:RESET SUMMER CAMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTENSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-973-4792
Mailing Address - Street 1:13100 VALLEYHEART DR APT 206
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1927
Mailing Address - Country:US
Mailing Address - Phone:909-973-4792
Mailing Address - Fax:
Practice Address - Street 1:955 LA PAZ RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108-1023
Practice Address - Country:US
Practice Address - Phone:909-973-4792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1699394676OtherTYPE 1 NPI