Provider Demographics
NPI:1124449889
Name:PACIFIC WEST COUNSELING CENTER INC
Entity type:Organization
Organization Name:PACIFIC WEST COUNSELING CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICK
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:AA
Authorized Official - Phone:818-623-4224
Mailing Address - Street 1:13636 VENTURA BLVD
Mailing Address - Street 2:SUITE 472
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3700
Mailing Address - Country:US
Mailing Address - Phone:818-623-4224
Mailing Address - Fax:818-981-0649
Practice Address - Street 1:6399 WILSHIRE BLVD
Practice Address - Street 2:SUITE 312
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5703
Practice Address - Country:US
Practice Address - Phone:323-651-5828
Practice Address - Fax:818-981-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31664106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty