Provider Demographics
NPI:1952866220
Name:BATTLE, CONNIE (LICENSE MASSAGE THER)
Entity Type:Individual
Prefix:PROF
First Name:CONNIE
Middle Name:
Last Name:BATTLE
Suffix:
Gender:F
Credentials:LICENSE MASSAGE THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21880 HAWTHORNE BLVD # 30533939
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-7031
Mailing Address - Country:US
Mailing Address - Phone:424-477-2168
Mailing Address - Fax:
Practice Address - Street 1:21880 HAWTHORNE BLVD # 30533939
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-7031
Practice Address - Country:US
Practice Address - Phone:424-477-2168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TH0004X, 103TC1900X
133N00000X, 221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist