Provider Demographics
NPI:1821607771
Name:TONYA OCTAVE, LCSW, PROF CORP
Entity Type:Organization
Organization Name:TONYA OCTAVE, LCSW, PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:OCTAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-387-8164
Mailing Address - Street 1:237 S LAKEVIEW AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6756
Mailing Address - Country:US
Mailing Address - Phone:714-705-0418
Mailing Address - Fax:
Practice Address - Street 1:237 S LAKEVIEW AVE STE A
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6756
Practice Address - Country:US
Practice Address - Phone:714-705-0418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health