Provider Demographics
NPI:1255594362
Name:LEIGHTYL SUBSTANCE ABUSE COUNSELING REFERAL PROGRAM
Entity type:Organization
Organization Name:LEIGHTYL SUBSTANCE ABUSE COUNSELING REFERAL PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-669-4123
Mailing Address - Street 1:18341 SHERMAN WAY
Mailing Address - Street 2:213
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4472
Mailing Address - Country:US
Mailing Address - Phone:818-669-4123
Mailing Address - Fax:
Practice Address - Street 1:18341 SHERMAN WAY
Practice Address - Street 2:213
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4472
Practice Address - Country:US
Practice Address - Phone:818-669-4123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management