Basic Information
| Provider Information | |||||||||
| NPI: | 1568582187 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPIRITT FAMILY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8000 PAINTER AVENUE | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629037000 | ||||||||
| FaxNumber: | 5626931803 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 TYLER AVENUE | ||||||||
| Address2: | |||||||||
| City: | SOUTH EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264421400 | ||||||||
| FaxNumber: | 6264421144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 06/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | TORRES | ||||||||
| AuthorizedOfficialFirstName: | ELVIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5629037000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.S., LMFT, MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 01160 | CA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 7527 | 01 | CA | MENTAL HEALTH MEDI-CAL | OTHER |