Provider Demographics
NPI:1467864587
Name:RESILIENT COMMUNITIES
Entity type:Organization
Organization Name:RESILIENT COMMUNITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TEKESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-619-4699
Mailing Address - Street 1:PO BOX 4204
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90224-4204
Mailing Address - Country:US
Mailing Address - Phone:310-619-4699
Mailing Address - Fax:310-935-4557
Practice Address - Street 1:18000 STUDEBAKER RD
Practice Address - Street 2:#700
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2679
Practice Address - Country:US
Practice Address - Phone:310-619-4699
Practice Address - Fax:310-935-4557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24698103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty