Provider Demographics
NPI:1346966736
Name:THE TRAVELING THERAPIST, INC.
Entity Type:Organization
Organization Name:THE TRAVELING THERAPIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:LUVONNE
Authorized Official - Middle Name:GENISE
Authorized Official - Last Name:RICHARDSON-KING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW 22396
Authorized Official - Phone:213-503-7590
Mailing Address - Street 1:702 W ATHENS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-3921
Mailing Address - Country:US
Mailing Address - Phone:213-503-7590
Mailing Address - Fax:
Practice Address - Street 1:702 W ATHENS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-3921
Practice Address - Country:US
Practice Address - Phone:213-503-7590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1235260399Medicaid