1346687779 NPI number — EMOTIONAL HEALTH ASSOCIATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346687779 NPI number — EMOTIONAL HEALTH ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMOTIONAL HEALTH ASSOCIATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SHARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346687779
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6666 GREEN VALLEY CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CULVER CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90230-7068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-846-5270
Provider Business Mailing Address Fax Number:
310-846-5278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6666 GREEN VALLEY CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CULVER CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90230-7068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-846-5270
Provider Business Practice Location Address Fax Number:
310-846-5278
Provider Enumeration Date:
05/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLMAN
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
310-846-5270

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 222540000 . This is a "COUNSELOR-MENTAL HEALTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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