Intensive Outpatient Eating Disorder Programs, Inc,

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

32565 Issued in CA

Legal business name

INTENSIVE OUTPATIENT EATING DISORDER PROGRAMS, INC,

Practice address

6325 Topanga Canyon Blvd
Ste. 305
Woodland Hills, CA 91367-2006

Phone

(818) 713-1312

Fax

(818) 713-1311

NPI assigned

Feb 8, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Darlene Joy Manickma, M.A. LMFT

Title

Executive Clinical Director

Phone

(818) 702-6322

Specialties & licenses 1

Addresses

Other names 1

• Safe Harbor Doing business as

Locations

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284595200000",
    "number": "1487795035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6325 TOPANGA CANYON BLVD",
            "address_2": "SUITE 305",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913672006",
            "telephone_number": "818-713-1312",
            "fax_number": "818-713-1311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6325 TOPANGA CANYON BLVD",
            "address_2": "STE. 305",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913672006",
            "telephone_number": "818-713-1312",
            "fax_number": "818-713-1311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTENSIVE OUTPATIENT EATING DISORDER PROGRAMS, INC,",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2010-09-16",
        "status": "A",
        "authorized_official_last_name": "MANICKMA",
        "authorized_official_first_name": "DARLENE",
        "authorized_official_middle_name": "JOY",
        "authorized_official_title_or_position": "EXECUTIVE CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "818-702-6322",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.A. LMFT"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "32565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Safe Harbor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Woodland Hills, CA
• Professional Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2010; 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.