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Organization
PRIDE PATHWAYS PROGRAM
Active
Organization
PRIDE PATHWAYS PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENTON LIPSCOMB (CHAIR PERSON)
(256) 345-9006
Entity
Organization
Contact information
Practice address
770 S GRAND AVE APT 2062, LOS ANGELES, CA 90017-3931
(310) 602-7586
Mailing address
3705 W PICO BLVD # 967, LOS ANGELES, CA 90019-3451
(323) 200-9602
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/25/2024
Last updated
03/15/2024
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