Provider Demographics
NPI:1831590942
Name:SOCAL CHILD THERAPY
Entity type:Organization
Organization Name:SOCAL CHILD THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GISELLE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:ASW
Authorized Official - Phone:917-517-7347
Mailing Address - Street 1:PO BOX 931774
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90093-1774
Mailing Address - Country:US
Mailing Address - Phone:917-517-7347
Mailing Address - Fax:
Practice Address - Street 1:5195 LINDLEY AVE
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4349
Practice Address - Country:US
Practice Address - Phone:818-804-0322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health