Organization
CLINICAL COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JACKI CONOLLEY (OWNER)
(818) 986-1161
Entity
Organization
Contact information
Practice address
15300 VENTURA BLVD, SUITE 503, SHERMAN OAKS, CA 91403-3103
(818) 986-1161
(818) 986-1161
Mailing address
15300 VENTURA BLVD, SUITE 503, SHERMAN OAKS, CA 91403-3103
(818) 986-1161
(818) 986-1161
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
MFT12148
CA
Other
Enumeration date
07/23/2009
Last updated
07/23/2009
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