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Organization

KOUESSEU SUPPORT FOUNDATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GISLENE KOUESSEU (CEO)
(424) 376-7211
Entity
Organization

Contact information

Practice address
2864 E FLORENCE AVE STE 101&102, HUNTINGTON PARK, CA 90255-5749
(424) 376-7211
Mailing address
2864 E FLORENCE AVE STE 101&102, HUNTINGTON PARK, CA 90255-5749
(424) 376-7211

Taxonomy

Speciality
Code
Description
License number
State
101YS0200X
School Counselor
103K00000X
Behavior Analyst
103TF0200X
Forensic Psychologist
163W00000X
Registered Nurse
164X00000X
Licensed Vocational Nurse
171M00000X
Case Manager/Care Coordinator
172V00000X
Community Health Worker
251S00000X
Community/Behavioral Health Agency
Primary
343900000X
Non-emergency Medical Transport (VAN)
373H00000X
Day Training/Habilitation Specialist

Other

Enumeration date
05/05/2026
Last updated
05/05/2026
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