Provider Demographics
NPI:1962882332
Name:AMANECER COMMUNITY COUNSELING SERVICE, A NON-PROFIT CORPORATION
Entity type:Organization
Organization Name:AMANECER COMMUNITY COUNSELING SERVICE, A NON-PROFIT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TEDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-481-7464
Mailing Address - Street 1:3680 E IMPERIAL HWY STE 480
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2662
Mailing Address - Country:US
Mailing Address - Phone:213-265-1099
Mailing Address - Fax:
Practice Address - Street 1:3680 E IMPERIAL HWY STE 480
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2662
Practice Address - Country:US
Practice Address - Phone:213-265-1099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2023-03-14
Deactivation Date:2022-07-01
Deactivation Code:
Reactivation Date:2022-07-28
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health