# IM POSSIBLE YOUTH FOUNDATION

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093052565
- **Authorized official:** MISS MILLICENT SHUNGU MAZAUWABA M.A. (CHEIF EXECUTIVE OFFICER)
- **Authorized official phone:** (310) 677-7080

## Contact information

- **Practice address:** 11011 CRENSHAW BLVD, SUITE 203, INGLEWOOD, CA 90303-6330
- **Practice address phone:** (310) 677-7080
- **Practice address fax:** (866) 894-5431
- **Mailing address:** 11011 CRENSHAW BLVD, SUITE 203, INGLEWOOD, CA 90303-6330
- **Mailing address phone:** (310) 677-7080
- **Mailing address fax:** (866) 894-5431

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 01/03/2013
- **Last updated:** 01/03/2013