Provider Demographics
NPI:1861026445
Name:PERSONALIZED TREATMENT & INTERVENTION SERVICES
Entity Type:Organization
Organization Name:PERSONALIZED TREATMENT & INTERVENTION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EARNESTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-379-5003
Mailing Address - Street 1:519 E HAZEL ST UNIT 17
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-5358
Mailing Address - Country:US
Mailing Address - Phone:916-904-4607
Mailing Address - Fax:
Practice Address - Street 1:519 E HAZEL ST UNIT 17
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-5358
Practice Address - Country:US
Practice Address - Phone:916-904-4607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-23
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)