Provider Demographics
NPI:1356880462
Name:ACORN FAMILY GUIDANCE CENTER, A PROFESSIONAL PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:ACORN FAMILY GUIDANCE CENTER, A PROFESSIONAL PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL CHILD PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:424-289-2725
Mailing Address - Street 1:12777 W JEFFERSON BLVD
Mailing Address - Street 2:BUILDING D, SUITE 300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-7048
Mailing Address - Country:US
Mailing Address - Phone:424-289-2725
Mailing Address - Fax:
Practice Address - Street 1:12777 W JEFFERSON BLVD
Practice Address - Street 2:BUILDING D, SUITE 300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-7048
Practice Address - Country:US
Practice Address - Phone:424-289-2725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28903251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health