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149 Pasadena Ave Ste A South Pasadena CA 91030-3351 | |
| (323) 254-2274 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 149 Pasadena Ave Ste A, South Pasadena, California |
| Authorized Official Name and Position | Stacey Roth (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3235432800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
149 Pasadena Ave Ste A South Pasadena CA 91030-3351 Ph: (323) 274-3065 | 149 Pasadena Ave Ste A South Pasadena CA 91030-3351 Ph: (323) 254-2274 |
| NPI Number | 1902920176 |
|---|---|
| Provider Enumeration Date | 03/16/2007 |
| Last Update Date | 01/04/2021 |
| Certification Date | 01/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902920176 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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