| Incredibly Inspirational, Inc | |
|
2009 Palo Verde Ave Ste A Long Beach CA 90815-3322 | |
| (562) 743-2389 | |
| Not Available |
| Full Name | Incredibly Inspirational, Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2009 Palo Verde Ave Ste A, Long Beach, California |
| Authorized Official Name and Position | Katherine Elaine Erickson (CEO) |
| Authorized Official Contact | 5627432389 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Incredibly Inspirational, Inc 6305 E Eliot St Long Beach CA 90803-2205 Ph: (562) 743-2389 | Incredibly Inspirational, Inc 2009 Palo Verde Ave Ste A Long Beach CA 90815-3322 Ph: (562) 743-2389 |
| NPI Number | 1639558232 |
|---|---|
| Provider Enumeration Date | 05/28/2015 |
| Last Update Date | 05/28/2015 |
| Medicare PECOS PAC ID | 1153753140 |
|---|---|
| Medicare Enrollment ID | O20191113000369 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639558232 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LCS 16061 (California) | Primary |
| Provider Name | Katherine Elaine Erickson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346379419 PECOS PAC ID: 5597946087 Enrollment ID: I20191113000633 |
| Provider Name | Andrea Sanserino |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740322452 PECOS PAC ID: 1759702384 Enrollment ID: I20200605001568 |
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