Provider Demographics
NPI:1821878075
Name:SUPPORT PATH THERAPY
Entity Type:Organization
Organization Name:SUPPORT PATH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:747-272-9983
Mailing Address - Street 1:PO BOX 5794
Mailing Address - Street 2:6444 SAN FERNANDO ROAD
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201
Mailing Address - Country:US
Mailing Address - Phone:747-272-9983
Mailing Address - Fax:
Practice Address - Street 1:1359 SONORA AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1411
Practice Address - Country:US
Practice Address - Phone:909-263-4307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty