The Therapeutic Dojo Psychotherapy Services a Professional Licensed CL

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

THE THERAPEUTIC DOJO PSYCHOTHERAPY SERVICES A PROFESSIONAL LICENSED CL

Practice address

1100 Wilshire Blvd Apt 2210
Los Angeles, CA 90017-1951

Phone

(949) 993-8606

NPI assigned

Sep 14, 2022

Last updated

Oct 14, 2022By 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

Tanicia Trotter, LCSW

Title

Director

Phone

(949) 993-8604

Specialties & licenses 1

Addresses

Other identifiers 3

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Makensy T Celestine

  • Clinical Social Worker
  • Los Angeles, CA
  • NPI 1275612657
  NPD

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

{
    "created_epoch": "1663113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665705600000",
    "number": "1336861517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917730043",
            "telephone_number": "949-993-8606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 WILSHIRE BLVD APT 2210",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900171951",
            "telephone_number": "949-993-8606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE THERAPEUTIC DOJO PSYCHOTHERAPY SERVICES A PROFESSIONAL LICENSED CL",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-14",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-14",
        "status": "A",
        "authorized_official_last_name": "TROTTER",
        "authorized_official_first_name": "TANICIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "949-993-8604",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1275612657",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA BOARD OF BEHAVIORAL SCIENCES",
            "identifier": "21067",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF HAWAII DEPT. OF COMMERCE AND CONSUMER AFFAIRS",
            "identifier": "4765",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• The Sue Medical Group
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• The Therapeutic Play Foundation Inc.
• The Therapeutic Play Foundation Inc. (Black Mental Health Task Force)
• The Therapeutic Play Foundation Inc.
• The Therapeutic Play Foundation Inc.
• The Towers Audiology Center

• Clinical Social Worker in Los Angeles, CA
• Providers in Los Angeles, 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 Oct 14, 2022; 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.