Provider Demographics
NPI:1982433801
Name:THERESA GOLDSTEIN, PROFESSIONAL CLINICAL COUSNELOR, P.C.
Entity type:Organization
Organization Name:THERESA GOLDSTEIN, PROFESSIONAL CLINICAL COUSNELOR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER, SECRETARY, TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:818-806-8767
Mailing Address - Street 1:2615 PCH HWY STE 325
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2236
Mailing Address - Country:US
Mailing Address - Phone:818-806-8767
Mailing Address - Fax:
Practice Address - Street 1:2615 PCH HWY STE 325
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2236
Practice Address - Country:US
Practice Address - Phone:818-806-8767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty