Provider Demographics
NPI:1487001921
Name:ACADEMY COUNSELING GROUP, INC
Entity Type:Organization
Organization Name:ACADEMY COUNSELING GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOI
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:626-378-2053
Mailing Address - Street 1:11072 SHARP AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1739
Mailing Address - Country:US
Mailing Address - Phone:626-378-2053
Mailing Address - Fax:
Practice Address - Street 1:11072 SHARP AVE
Practice Address - Street 2:A
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1739
Practice Address - Country:US
Practice Address - Phone:626-378-2053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty