Basic Information
| Provider Information | |||||||||
| NPI: | 1023147139 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | D'VEAL FAMILY & YOUTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2750 E WASHINGTON BLVD | ||||||||
| Address2: | SUITE 230 AND 240 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911071448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262968900 | ||||||||
| FaxNumber: | 6264058973 | ||||||||
| Practice Location | |||||||||
| Address1: | 2750 E WASHINGTON BLVD | ||||||||
| Address2: | SUITE 230, 240, 250, 260 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911071448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262968900 | ||||||||
| FaxNumber: | 6264058973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 02/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCCALL | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | TERRY | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/D'VEAL FAMILY & YOUTH SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 6262968900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 02/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | LCSW11363 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.