Wings of the Future Private Practice LCSW PC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

WINGS OF THE FUTURE PRIVATE PRACTICE LCSW PC

Doing business as

Wings of the Future Consulting Private Practice

Practice address

117 E Colorado Blvd Ste 3600
Pasadena, CA 91105-1938

Phone

(661) 402-1545

Fax

(661) 727-0006

NPI assigned

Sep 28, 2018

Organization subpart

No

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

Authorized official

Name

Krystal M Boothe, LCSWNPI 1043488414

Title

Executive Director

Phone

(661) 402-1545

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Wings of the Future Consulting Private Practice Doing business as

Electronic endpoints 1

Tax ID family

Wings of the Future Consulting Private Practice2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Wings of the Future Consulting Private Practice

  • Clinical Social Worker
  • Pasadena, CA
  • NPI 1649944430
  NPD tax ID

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Krystal Marie Boothe, LCSW

  • Clinical Social Worker
  • Pasadena, CA
  • NPI 1043488414
  NPD Authorized official
• Deanna Aghbashian

  • Clinical Social Worker
  • Newport Beach, CA
  • NPI 1104343144
  NPD
• Abigail Escatel

  • Professional Counselor
  • Pasadena, CA
  • NPI 1417491051
  NPD (past)
• Juliette Elizabeth Kurth

  • School Social Worker
  • Pasadena, CA
  • NPI 1356821698
  NPD (past)
• Mary Elizabeth Marrone, MSW, ACSW

  • Social Worker
  • Pasadena, CA
  • NPI 1063990349
  NPD (past)
• Alex David Ross, ACSW

  • Clinical Social Worker
  • Pasadena, CA
  • NPI 1952961666
  NPD (past)

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

{
    "created_epoch": "1538092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679616000000",
    "number": "1144705724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 E COLORADO BLVD STE 600",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911051938",
            "telephone_number": "661-402-1545",
            "fax_number": "661-727-0006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 E COLORADO BLVD STE 3600",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911051938",
            "telephone_number": "661-402-1545",
            "fax_number": "661-727-0006"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1050 Lakes Dr Ste 225",
            "address_purpose": "LOCATION",
            "city": "West Covina",
            "state": "CA",
            "postal_code": "917902910",
            "country_code": "US",
            "telephone_number": "661-402-1545",
            "fax_number": "661-727-0006",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "663 West 5th Street",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900711502",
            "country_code": "US",
            "telephone_number": "661-402-1545",
            "fax_number": "661-727-0006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WINGS OF THE FUTURE PRIVATE PRACTICE LCSW PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-28",
        "last_updated": "2023-03-24",
        "certification_date": "2023-03-24",
        "status": "A",
        "authorized_official_last_name": "BOOTHE",
        "authorized_official_first_name": "KRYSTAL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "661-402-1545",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS LICENSE",
            "identifier": "03066046",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP",
            "identifier": "CB394408",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kboothe@wingsofthefuture4us.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "1050 Lakes Dr Ste 225",
            "city": "West Covina",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917902910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Wings of the Future Consulting Private Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrea Winbush
• Eric Winegar, L.V.N
• Jason Thomas Frasier Wing
• Diann Michele Wingert, LCSW, BCD
• Wings of the Future Consulting Private Practice
• Tabitha Winkey
• Erika Winkler, MS, RD, CNSC, CSO
• Ashley Winter, M.D.
• Jaime Winterrose
• Frances Karen Wintroub, PHD, LCSW

• Clinical Social Worker in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2023; 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.