Thespacebetweencounselingserviceslicensedclinicalsocialworkerinc

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

THESPACEBETWEENCOUNSELINGSERVICESLICENSEDCLINICALSOCIALWORKERINC

Practice address

12139 Mount Vernon Ave Ste 200a
Grand Terrace, CA 92313-5547

Phone

(951) 465-5812

Fax

(951) 346-5680

NPI assigned

Dec 29, 2020

Organization subpart

No

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

Authorized official

Name

Mrs. Zuelika C Xicotencatl, LCSW

Title

LCSW

Phone

(951) 465-5812

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1609200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609200000000",
    "number": "1457948077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12139 MOUNT VERNON AVE STE 200A",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135547",
            "telephone_number": "951-465-5812",
            "fax_number": "951-346-5680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12139 MOUNT VERNON AVE STE 200A",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135547",
            "telephone_number": "951-465-5812",
            "fax_number": "951-346-5680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THESPACEBETWEENCOUNSELINGSERVICESLICENSEDCLINICALSOCIALWORKERINC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-29",
        "last_updated": "2020-12-29",
        "certification_date": "2020-12-29",
        "status": "A",
        "authorized_official_last_name": "XICOTENCATL",
        "authorized_official_first_name": "ZUELIKA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "LCSW",
        "authorized_official_telephone_number": "951-465-5812",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Grand Terrace, CA
• Providers in Grand Terrace, 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 Dec 29, 2020; 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.