Provider Demographics
NPI:1740694488
Name:KHEPER LIFE ENRICHMENT INSTITUTE
Entity type:Organization
Organization Name:KHEPER LIFE ENRICHMENT INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:CHERYL
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MFTI
Authorized Official - Phone:323-750-7550
Mailing Address - Street 1:3406 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-4926
Mailing Address - Country:US
Mailing Address - Phone:323-750-7550
Mailing Address - Fax:
Practice Address - Street 1:3406 W 75TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-4926
Practice Address - Country:US
Practice Address - Phone:323-750-7550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 15637251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management