Basic Information
| Provider Information | |||||||||
| NPI: | 1487773826 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHILD &FAMILY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12166 CANYON HILL AVE | ||||||||
| Address2: | |||||||||
| City: | SYLMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913425496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612447646 | ||||||||
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| Practice Location | |||||||||
| Address1: | 21545 CENTRE POINTE PKWY | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913502947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612599439 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | AVALOS | ||||||||
| AuthorizedOfficialFirstName: | SORAYA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CASE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6612599439 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.