Organization
10-20 CLUB INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONNIE FERNANDEZ LCSW (EXECUTIVE DIRECTOR)
(323) 793-3595
Entity
Organization
Contact information
Practice address
10810 PARAMOUNT BLVD STE 202, DOWNEY, CA 90241-3351
(562) 294-3315
Mailing address
10810 PARAMOUNT BLVD STE 202, DOWNEY, CA 90241-3351
(562) 294-3315
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
10/20/2020
Last updated
12/05/2022
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