Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Organization
YOUR LIFE SERVICE LEAGUE LICENSED CLINICAL SOCIAL WORKER APC
Active
Organization
YOUR LIFE SERVICE LEAGUE LICENSED CLINICAL SOCIAL WORKER APC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LANDON DERRICK HALLBROOKS LCSW (CHIEF EXECUTIVE OFFICER)
(951) 850-1574
Entity
Organization
Contact information
Practice address
435 W MISSION BLVD STE 301, POMONA, CA 91766-1632
(951) 850-1574
Mailing address
300 S PARK AVE STE 820, POMONA, CA 91766-1501
(951) 850-1574
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
09/03/2020
Last updated
05/18/2022
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up