Provider Demographics
NPI:1265189831
Name:EMANATE PROFESSIONAL CLINICAL COUNSELOR INC
Entity type:Organization
Organization Name:EMANATE PROFESSIONAL CLINICAL COUNSELOR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSI
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:BLANK
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:626-788-3065
Mailing Address - Street 1:PO BOX 7269
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91409-7269
Mailing Address - Country:US
Mailing Address - Phone:818-515-3879
Mailing Address - Fax:
Practice Address - Street 1:425 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-8313
Practice Address - Country:US
Practice Address - Phone:626-788-3065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-03
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)