Basic Information
| Provider Information | |||||||||
| NPI: | 1922518497 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEXT MOVE MENTAL HEALTH AGENCY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 155 | ||||||||
| Address2: | |||||||||
| City: | LAWNDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902600155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105920337 | ||||||||
| FaxNumber: | 2134022101 | ||||||||
| Practice Location | |||||||||
| Address1: | 14717 HAWTHORNE BLVD STE C | ||||||||
| Address2: | |||||||||
| City: | LAWNDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902601580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103550432 | ||||||||
| FaxNumber: | 2134022101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2017 | ||||||||
| LastUpdateDate: | 02/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | MAKOUIE | ||||||||
| AuthorizedOfficialFirstName: | BAHBAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3105920337 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MFT | ||||||||
| NPICertificationDate: | 02/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 52448 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.