Basic Information
| Provider Information | |||||||||
| NPI: | 1669658894 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LA FAMILIA COUNSELING SERVICE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EL CHANTE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26081 MOCINE AVENUE | ||||||||
| Address2: | |||||||||
| City: | HAYWARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945442923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108815921 | ||||||||
| FaxNumber: | 5103000228 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 VERNON STREET | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946102927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104654569 | ||||||||
| FaxNumber: | 5102919591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2008 | ||||||||
| LastUpdateDate: | 05/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | ORTIZ | ||||||||
| AuthorizedOfficialFirstName: | AARON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5108815921 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.