Basic Information
Provider Information | |||||||||
NPI: | 1346687779 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | EMOTIONAL HEALTH ASSOCIATION | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SHARE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6666 GREEN VALLEY CIR | ||||||||
Address2: |   | ||||||||
City: | CULVER CITY | ||||||||
State: | CA | ||||||||
PostalCode: | 902307068 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3108465270 | ||||||||
FaxNumber: | 3108465278 | ||||||||
Practice Location | |||||||||
Address1: | 6666 GREEN VALLEY CIR | ||||||||
Address2: |   | ||||||||
City: | CULVER CITY | ||||||||
State: | CA | ||||||||
PostalCode: | 902307068 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3108465270 | ||||||||
FaxNumber: | 3108465278 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/24/2013 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HOLLMAN | ||||||||
AuthorizedOfficialFirstName: | RUTH | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 3108465270 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251V00000X |   | CA | Y |   | Agencies | Voluntary or Charitable |   |
ID Information
ID | Type | State | Issuer | Description | 222540000 | 01 | CA | COUNSELOR-MENTAL HEALTH | OTHER |