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Organization
BLUE CHAIR FOUNDATION
Active
Organization
BLUE CHAIR FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY M. CORNWALL MS (EXECUTIVE DIRECTOR)
(424) 350-8398
Entity
Organization
Contact information
Practice address
2512 ARTESIA BLVD STE 110, REDONDO BEACH, CA 90278-3265
(310) 974-0533
Mailing address
2512 ARTESIA BLVD STE 110, REDONDO BEACH, CA 90278-3265
(310) 974-0533
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
NULL
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
—
NULL
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
—
NULL
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
NULL
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
104100000X
Social Worker
—
NULL
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
106E00000X
Assistant Behavior Analyst
—
NULL
106E00000X
Assistant Behavior Analyst
—
—
106H00000X
Marriage & Family Therapist
Primary
—
NULL
106H00000X
Marriage & Family Therapist
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
NULL
171M00000X
Case Manager/Care Coordinator
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
NULL
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
NULL
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Enumeration date
06/27/2024
Last updated
06/27/2024
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