Provider Demographics
NPI:1063881894
Name:CENTER FOR INTEGRATED CARE
Entity type:Organization
Organization Name:CENTER FOR INTEGRATED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:818-231-9476
Mailing Address - Street 1:15340 DEVONSHIRE ST STE 7
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2760
Mailing Address - Country:US
Mailing Address - Phone:323-538-0975
Mailing Address - Fax:818-484-4084
Practice Address - Street 1:15340 DEVONSHIRE ST STE 7
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2760
Practice Address - Country:US
Practice Address - Phone:323-538-0975
Practice Address - Fax:818-484-4084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC50211101YM0800X
2084P0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063881894Medicaid
CA1063881894OtherCOMMERCIAL INSURANCE