| Wings Of The Future Consulting Private Practice | |
|
1050 Lakes Dr Ste 225 West Covina CA 91790-2910 | |
| (661) 402-1545 | |
| (661) 727-0006 |
| Full Name | Wings Of The Future Consulting Private Practice |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1050 Lakes Dr Ste 225, West Covina, California |
| Authorized Official Name and Position | Krystal Marie Boothe (CEO/EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6614021545 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wings Of The Future Consulting Private Practice 1050 Lakes Dr Ste 225 West Covina CA 91790-2910 Ph: (661) 402-1545 | Wings Of The Future Consulting Private Practice 1050 Lakes Dr Ste 225 West Covina CA 91790-2910 Ph: (661) 402-1545 |
| NPI Number | 1649944430 |
|---|---|
| Provider Enumeration Date | 08/04/2021 |
| Last Update Date | 10/26/2022 |
| Certification Date | 10/26/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649944430 | NPI | - | NPPES |
| 83-2422898 | Other | CA | IRS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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