| Wings Of The Future Consulting Private Practice | |
|
117 E Colorado Blvd Ste 3600 Pasadena CA 91105-1938 | |
| (661) 402-1545 | |
| (661) 727-0006 |
| Full Name | Wings Of The Future Consulting Private Practice |
|---|---|
| Speciality | Social Worker |
| Location | 117 E Colorado Blvd Ste 3600, Pasadena, California |
| Authorized Official Name and Position | Krystal M Boothe (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6614021545 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wings Of The Future Consulting Private Practice 117 E Colorado Blvd Ste 600 Pasadena CA 91105-1938 Ph: (661) 402-1545 | Wings Of The Future Consulting Private Practice 117 E Colorado Blvd Ste 3600 Pasadena CA 91105-1938 Ph: (661) 402-1545 |
| NPI Number | 1144705724 |
|---|---|
| Provider Enumeration Date | 09/28/2018 |
| Last Update Date | 03/24/2023 |
| Certification Date | 03/24/2023 |
| Medicare PECOS PAC ID | 8729488440 |
|---|---|
| Medicare Enrollment ID | O20220223000697 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144705724 | NPI | - | NPPES |
| 03066046 | Other | CA | BUSINESS LICENSE |
| CB394408 | Other | CA | GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Krystal Marie Boothe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043488414 PECOS PAC ID: 5991086571 Enrollment ID: I20161220001977 |
| Provider Name | Deanna Aghbashian |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104343144 PECOS PAC ID: 8224407564 Enrollment ID: I20221208002591 |
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