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Organization
THE SOURCE HEALTH AND WELLNESS TREATMENT CENTER
Active
Organization
THE SOURCE HEALTH AND WELLNESS TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON LEVINE PH.D. (PRESIDENT AND EXECUTIVE DIRECTOR)
(310) 477-8140
Entity
Organization
Contact information
Practice address
11150 W OLYMPIC BLVD STE 760, LOS ANGELES, CA 90064-1817
(310) 477-8140
Mailing address
11150 W OLYMPIC BLVD STE 760, LOS ANGELES, CA 90064-1817
(310) 477-8140
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
NULL
Other
Enumeration date
09/06/2013
Last updated
09/06/2013
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