| Emanate Professional Clinical Counselor Inc | |
|
425 Country Club Dr Simi Valley CA 93065-8313 | |
| (626) 788-3065 | |
| Not Available |
| Full Name | Emanate Professional Clinical Counselor Inc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 425 Country Club Dr, Simi Valley, California |
| Authorized Official Name and Position | Jessi Frances Blank (THERAPIST) |
| Authorized Official Contact | 6267883065 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Emanate Professional Clinical Counselor Inc Po Box 7269 Van Nuys CA 91409-7269 Ph: (818) 515-3879 | Emanate Professional Clinical Counselor Inc 425 Country Club Dr Simi Valley CA 93065-8313 Ph: (626) 788-3065 |
| NPI Number | 1265189831 |
|---|---|
| Provider Enumeration Date | 03/03/2022 |
| Last Update Date | 03/07/2022 |
| Certification Date | 03/07/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265189831 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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