Epiphany Counseling, Consulting & Treatment Services, PC
Organization Active NPI Clinical Social Worker · San Pedro, CA
NPI 1376922328 · NPPES record last updated Oct 4, 2016
Key facts
- NPI
- 1376922328
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LCSW64555 (CA)
- Legal business name
- EPIPHANY COUNSELING, CONSULTING & TREATMENT SERVICES, PC
- Practice address
- 302 W 5TH St Ste 308
San Pedro, CA 90731-2750 - Phone
- (424) 376-8705
- Fax
- (424) 363-1721
- NPI assigned
- May 22, 2015
- Organization subpart
- No
Authorized official
- Name
- Miyume McKinley, LCSW
- Title
- Owner
- Phone
- (424) 570-6955
Practitioners 43
-
Miyume M. McKinley, LCSW
-
Nina Ashrafzadeh, PSY.D., LMFT
-
Chanelle Haywood, LMFT
-
Esther Jou, LMFT
-
Bryan Smith, PSS
-
Ruben Arancibia, LCSW
-
Ebony K Cobb, MA, AMFT, APCC
-
Kirsten Filson, LMFT
-
Carole A Garcia, MFT
-
Londen Selina Gatewood, LMFT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161004002053 | CA | Part B Supplier - Clinic/Group Practice | 2062700214 |
Receives reassigned benefits from 1 practitioner Practice locations: San Pedro, CA |
National Provider Directory
Locations
3320 S Central Ave
Los Angeles, CA 90011
302 W 5th St
Ste 308
San Pedro, CA 90731
Phone (424) 570-6955
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | |||
| Clinical Social Worker |
1041C0700X | LCSW64555 | CA | Yes |
Addresses
Primary practice location
302 W 5TH St Ste 308
San Pedro, CA 90731-2750
Mailing address
302 W 5TH St Ste 308
San Pedro, CA 90731-2750
Phone (424) 570-6955
Other providers in San Pedro, CA
- Elyasi Chiropractic, Apc
- Elyasi del Torto Chiropractic, Inc.
- Emmett Cox II, M.D., a Professional Corporation
- Roger Lee Engelbert
- Jamar Ephform
- Eric Kardovich, DMD, Inc.
- Eric M Feit DPM Inc
- Erica a Wicke M.a. Licensed Marriage and Family Therapist Inc.
- Eshghi Chiropractic Inc
- Ramin Eshghi
All providers in San Pedro, CA · Clinical Social Worker in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.