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Organization
WINGS OF THE FUTURE PRIVATE PRACTICE LCSW PC
Active
Organization
WINGS OF THE FUTURE PRIVATE PRACTICE LCSW PC
Active
Other names
Wings of the Future Consulting Private Practice
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTAL M BOOTHE LCSW (EXECUTIVE DIRECTOR)
(661) 402-1545
Entity
Organization
Contact information
Practice address
117 E COLORADO BLVD STE 3600, PASADENA, CA 91105-1938
(661) 402-1545
(661) 727-0006
Mailing address
117 E COLORADO BLVD STE 600, PASADENA, CA 91105-1938
(661) 402-1545
(661) 727-0006
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03066046
BUSINESS LICENSE
CA
01
—
CB394408
GROUP
CA
Enumeration date
09/28/2018
Last updated
03/24/2023
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