| Epiphany Counseling, Consulting & Treatment Services, Pc | |
|
302 W 5th St Ste 308 San Pedro CA 90731-2750 | |
| (424) 376-8705 | |
| (424) 363-1721 |
| Full Name | Epiphany Counseling, Consulting & Treatment Services, Pc |
|---|---|
| Speciality | Social Worker |
| Location | 302 W 5th St Ste 308, San Pedro, California |
| Authorized Official Name and Position | Miyume Mckinley (OWNER) |
| Authorized Official Contact | 4245706955 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Epiphany Counseling, Consulting & Treatment Services, Pc 302 W 5th St Ste 308 San Pedro CA 90731-2750 Ph: (424) 570-6955 | Epiphany Counseling, Consulting & Treatment Services, Pc 302 W 5th St Ste 308 San Pedro CA 90731-2750 Ph: (424) 376-8705 |
| NPI Number | 1376922328 |
|---|---|
| Provider Enumeration Date | 05/22/2015 |
| Last Update Date | 10/04/2016 |
| Medicare PECOS PAC ID | 2062700214 |
|---|---|
| Medicare Enrollment ID | O20161004002053 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376922328 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | LCSW64555 (California) | Primary |
| Provider Name | Miyume Mckinley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285812875 PECOS PAC ID: 3971891128 Enrollment ID: I20161005001108 |
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