Basic Information
| Provider Information | |||||||||
| NPI: | 1922642685 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERFACE CHILDREN AND FAMILY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4001 MISSION OAKS BLVD STE I | ||||||||
| Address2: | |||||||||
| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930125121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054856114 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1746 S VICTORIA AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930035806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054856114 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2019 | ||||||||
| LastUpdateDate: | 11/05/2019 | ||||||||
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| AuthorizedOfficialLastName: | FLOURNOY | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | ELIZABETH | ||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED CLINICAL SERVICES MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8054856114 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.