Provider Demographics
NPI:1851768568
Name:K&S THERAPEUTIC SERVICES, INC.
Entity Type:Organization
Organization Name:K&S THERAPEUTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YESHIVA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, MBA
Authorized Official - Phone:617-320-9247
Mailing Address - Street 1:5601 W SLAUSON AVE
Mailing Address - Street 2:SUITE 178
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6582
Mailing Address - Country:US
Mailing Address - Phone:617-320-9247
Mailing Address - Fax:310-388-1386
Practice Address - Street 1:5601 W SLAUSON AVE
Practice Address - Street 2:SUITE 178
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6582
Practice Address - Country:US
Practice Address - Phone:617-320-9247
Practice Address - Fax:310-388-1386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW601001041C0700X
CALMFT52250106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty