Provider Demographics
NPI:1043086945
Name:JULIA-ELISE CHILDS THERAPY: A LICENSED CLINICAL SOCIAL WORKER CORP.
Entity type:Organization
Organization Name:JULIA-ELISE CHILDS THERAPY: A LICENSED CLINICAL SOCIAL WORKER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA-ELISE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:626-765-5308
Mailing Address - Street 1:281 E COLORADO BLVD # 2395
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1903
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 E DEL MAR BLVD STE 160
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2507
Practice Address - Country:US
Practice Address - Phone:626-765-5308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)