Im Possible Youth Foundation

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Legal business name

IM POSSIBLE YOUTH FOUNDATION

Practice address

11011 Crenshaw Blvd
Suite 203
Inglewood, CA 90303-6330

Phone

(310) 677-7080

Fax

(866) 894-5431

NPI assigned

Jan 3, 2013

Last updated

Jan 3, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Millicent Shungu Mazauwaba, M.A.

Title

Cheif Executive Officer

Phone

(310) 677-7080

Specialties & licenses 3

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357171200000",
    "number": "1093052565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11011 CRENSHAW BLVD",
            "address_2": "SUITE 203",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903036330",
            "telephone_number": "310-677-7080",
            "fax_number": "866-894-5431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11011 CRENSHAW BLVD",
            "address_2": "SUITE 203",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903036330",
            "telephone_number": "310-677-7080",
            "fax_number": "866-894-5431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IM POSSIBLE YOUTH FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-03",
        "last_updated": "2013-01-03",
        "status": "A",
        "authorized_official_last_name": "MAZAUWABA",
        "authorized_official_first_name": "MILLICENT",
        "authorized_official_middle_name": "SHUNGU",
        "authorized_official_title_or_position": "CHEIF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "310-677-7080",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Inglewood, CA
• Providers in Inglewood, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.