Organization
LIFTED FOUNDATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TANYATTA CHATEAU LCSW (CLINICAL SOCIAL WORKER/ MANAGER)
(818) 606-9836
Entity
Organization
Contact information
Practice address
8363 RESEDA BLVD, SUITE 203 E, NORTHRIDGE, CA 91324-4623
(818) 727-7742
Mailing address
8363 RESEDA BLVD, SUITE 203 E, NORTHRIDGE, CA 91324-4623
(818) 727-7742
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
LCS 23309
CA
251S00000X
Community/Behavioral Health Agency
LCS 23309
CA
Other
Enumeration date
05/19/2014
Last updated
11/05/2014
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