Provider Demographics
NPI:1942508320
Name:SOUTH BAY CENTER FOR COUNSELING
Entity Type:Organization
Organization Name:SOUTH BAY CENTER FOR COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-414-2090
Mailing Address - Street 1:360 N SEPULVEDA BLVD
Mailing Address - Street 2:2075
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4460
Mailing Address - Country:US
Mailing Address - Phone:310-414-2090
Mailing Address - Fax:310-414-2096
Practice Address - Street 1:360 N SEPULVEDA BLVD
Practice Address - Street 2:2075
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4460
Practice Address - Country:US
Practice Address - Phone:310-414-2090
Practice Address - Fax:310-414-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health