Provider Demographics
NPI:1972634939
Name:PROSPERITY COUNSELING & TREATMENT SVCS
Entity type:Organization
Organization Name:PROSPERITY COUNSELING & TREATMENT SVCS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PAYER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MAGDALEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSTILO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-568-7667
Mailing Address - Street 1:18401 VON KARMAN AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-8531
Mailing Address - Country:US
Mailing Address - Phone:714-828-1800
Mailing Address - Fax:714-882-1186
Practice Address - Street 1:5001 112TH ST E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98446-5307
Practice Address - Country:US
Practice Address - Phone:714-828-1800
Practice Address - Fax:714-882-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARTF1042324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility