THE SOURCE HEALTH AND WELLNESS TREATMENT CENTER (NPI# 1700211984) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700211984 |
| Entity Type | Organization |
| Organization Name | THE SOURCE HEALTH AND WELLNESS TREATMENT CENTER |
| Practice Address |
11150 W Olympic Blvd Ste 760 Los Angeles CA 90064-1817 |
| Practice Telephone | 3104778140 |
| Mailing Telephone | 3104778140 |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2013-09-06 |
| Authorized Official Name | DR. JASON LEVINE (PRESIDENT AND EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 3104778140 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Street Address |
11150 W OLYMPIC BLVD STE 760 |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90064-1817 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295016962 | Ellen Arthur Michel | Counselor | 11150 W Olympic Blvd Ste 760, Los Angeles, CA 90064-1855 | 2011-09-07 |
| 1144848110 | Harmony Rousseau | Counselor | 11150 W Olympic Blvd Ste 760, Los Angeles, CA 90064-1855 | 2020-07-07 |
| 1023658812 | Jessica Fox | Marriage & Family Therapist | 11150 W Olympic Blvd Ste 760, Los Angeles, CA 90064-1855 | 2020-01-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134727597 | Barbara K. Polland | Marriage & Family Therapist | 10533 Rountree Rd., Los Angeles, CA 90064 | 2020-10-16 |
| 1912542994 | Reproductive Medicine Associates of Socal Ambulatory Surgery Center | Clinic/Center | 11500 W Olympic Blvd, Ste# 150, Los Angeles, CA 90064 | 2019-11-13 |
| 1376022012 | Payersdirect, Inc. | Radiology | 11845 W Olympic Blvd Ste 1100w, Los Angeles, CA 90064 | 2018-08-13 |
| 1013404136 | Jeannie Wakamatsu | Dietitian, Registered | 10312 Almayo Ave., Suite 6, Los Angeles, CA 90064 | 2018-04-13 |
| 1487153474 | Victor Louie | Behavior Technician | 11835 W Olympic Blvd Suite 140e, Los Angeles, CA 90064 | 2018-02-06 |
| 1538683842 | Ana Grinfeld | Behavioral Analyst | 11835 W Olympic Blvd Ste 140e, Los Angeles, CA 90064 | 2017-07-28 |
| 1407386089 | Ovsanna Stepanyan | Rehabilitation Practitioner | 11080 W Olimpic Blvd, La, CA 90064 | 2017-06-15 |
| 1952768012 | Grace Gayles | Behavioral Analyst | 11835 W. Olympic Blvd., Suite 140e, Los Angeles, CA 90064 | 2016-01-20 |
| 1669841003 | Jessica Hildebrandt | Occupational Therapy Assistant | 2446 S Westgate Ave, Los Angeles, CA 90064 | 2015-09-16 |
| 1033592571 | Joshua Busse | Family Medicine | 11845 Olympic Boulevard, Los Angeles, CA 90064 | 2015-07-01 |
| Find all providers in zip 90064 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740881861 | Griselda Tuchan Pineda Marriage and Family Therapist Inc | Community/Behavioral Health | 2820 S Vermont Ave Ste 16, Los Angeles, CA 90007-2291 | 2020-11-04 |
| 1376142216 | Melissa Reyes Aguilar | Community/Behavioral Health | 2248 S Cochran Ave, Los Angeles, CA 90016-1218 | 2020-10-21 |
| 1841807666 | Didi Hirsch Psychiatric Service | Community/Behavioral Health | 10101 S Broadway, Los Angeles, CA 90003-4534 | 2020-09-25 |
| 1730795188 | Connect Therapies | Community/Behavioral Health | 801 S Beverly Glen Blvd, Los Angeles, CA 90024-4603 | 2020-09-21 |
| 1396358735 | United Therapy Center,inc | Community/Behavioral Health | 12777 W Jefferson Blvd # D3020, Los Angeles, CA 90066-7048 | 2020-08-25 |
| 1174149769 | Amanecer Community Counseling Service, A Non-profit Corporation | Community/Behavioral Health | 3750 W 6th St, Los Angeles, CA 90020-5100 | 2020-06-19 |
| 1902421290 | Exceptional Wellness of California Incorporated | Community/Behavioral Health | 626 Wilshire Blvd Ste 410, Los Angeles, CA 90017-2915 | 2020-06-11 |
| 1043831878 | Didi Hirsch Psychiatric Service | Community/Behavioral Health | 9179 S Main Street, Los Angeles, CA 90003 | 2020-05-04 |
| 1780226977 | Children's Institute, Inc. | Community/Behavioral Health | 7001 S St Andrews Pl, Los Angeles, CA 90047-1833 | 2019-10-09 |
| 1780238675 | Igcn Healthcare Partners | Community/Behavioral Health | 6153 Colgate Ave, Los Angeles, CA 90036-3127 | 2019-07-29 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90064 |
Please comment or provide details below to improve the information on THE SOURCE HEALTH AND WELLNESS TREATMENT CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.