Provider Demographics
NPI:1871163386
Name:MOVEMENT TALK THERAPY, LICENSED CLINICAL SOCIAL WORKER, INC.
Entity type:Organization
Organization Name:MOVEMENT TALK THERAPY, LICENSED CLINICAL SOCIAL WORKER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:415-812-3240
Mailing Address - Street 1:750 E 5TH ST UNIT 6
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-3876
Mailing Address - Country:US
Mailing Address - Phone:415-812-3240
Mailing Address - Fax:
Practice Address - Street 1:750 E 5TH ST UNIT 6
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-3876
Practice Address - Country:US
Practice Address - Phone:415-812-3240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty