Provider Demographics
NPI:1205343076
Name:MOMENTUM LEARNING
Entity type:Organization
Organization Name:MOMENTUM LEARNING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUNNYO
Authorized Official - Middle Name:
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:619-521-5720
Mailing Address - Street 1:3288 EL CAJON BLVD #13
Mailing Address - Street 2:
Mailing Address - City:SD
Mailing Address - State:CA
Mailing Address - Zip Code:92104
Mailing Address - Country:US
Mailing Address - Phone:619-521-5720
Mailing Address - Fax:619-521-5728
Practice Address - Street 1:3720 EL CAJON BLVD.
Practice Address - Street 2:
Practice Address - City:SD
Practice Address - State:CA
Practice Address - Zip Code:92105
Practice Address - Country:US
Practice Address - Phone:619-521-5720
Practice Address - Fax:619-521-5728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty