Individual
BIENVILLE SOUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3660 W SLAUSON AVE, LOS ANGELES, CA 90043-2931
(323) 214-9166
Mailing address
3660 W SLAUSON AVE, LOS ANGELES, CA 90043-2931
(323) 214-9166
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
103K00000X
Behavior Analyst
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TF0000X
Family Psychologist
—
CA
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
104100000X
Social Worker
—
CA
104100000X
Social Worker
Primary
—
—
171000000X
Military Health Care Provider
—
—
171M00000X
Case Manager/Care Coordinator
—
—
172A00000X
Driver
—
—
174N00000X
Lactation Consultant (Non-RN)
—
—
221700000X
Art Therapist
—
—
Other
Enumeration date
03/19/2018
Last updated
03/19/2018
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