Provider Demographics
NPI:1952077786
Name:EUBANK ON WELLNESS LLC
Entity type:Organization
Organization Name:EUBANK ON WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASAMAU
Authorized Official - Middle Name:
Authorized Official - Last Name:OJARIGI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:763-742-4440
Mailing Address - Street 1:1200 N VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221
Mailing Address - Country:US
Mailing Address - Phone:310-896-3946
Mailing Address - Fax:
Practice Address - Street 1:100 WEST 64TH ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302
Practice Address - Country:US
Practice Address - Phone:310-896-3946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty