Basic Information
| Provider Information | |||||||||
| NPI: | 1861724296 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHEEL OF WELLBEING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1575 WESTWOOD BLVD | ||||||||
| Address2: | 205 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900245620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104778833 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1575 WESTWOOD BLVD | ||||||||
| Address2: | 205 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900245620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104778833 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2010 | ||||||||
| LastUpdateDate: | 02/10/2010 | ||||||||
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| AuthorizedOfficialLastName: | SHAW | ||||||||
| AuthorizedOfficialFirstName: | LARRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3104778833 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MFC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC17578 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.