Provider Demographics
NPI:1912405630
Name:SOCIAL SERVICES OF SOUTHERN CALIFORNIA A LICENSED CLINICAL SOCIAL WORK
Entity Type:Organization
Organization Name:SOCIAL SERVICES OF SOUTHERN CALIFORNIA A LICENSED CLINICAL SOCIAL WORK
Other - Org Name:YOUR SPACE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:PAOLA
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:760-364-8229
Mailing Address - Street 1:78150 CALLE TAMPICO STE 200C
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-7406
Mailing Address - Country:US
Mailing Address - Phone:760-364-8229
Mailing Address - Fax:
Practice Address - Street 1:78150 CALLE TAMPICO STE 200C
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-7406
Practice Address - Country:US
Practice Address - Phone:760-364-8229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW744891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty