| Abundance Therapy Center | |
|
4221 Wilshire Blvd Ste 170-16 Los Angeles CA 90010-3519 | |
| (213) 441-6780 | |
| Not Available |
| Full Name | Abundance Therapy Center |
|---|---|
| Speciality | Social Worker |
| Location | 4221 Wilshire Blvd Ste 170-16, Los Angeles, California |
| Authorized Official Name and Position | Christine Chae (DIRECTOR/THERAPIST) |
| Authorized Official Contact | 2134416780 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Abundance Therapy Center 4221 Wilshire Blvd Ste 170-16 Los Angeles CA 90010-3519 Ph: (213) 441-6780 | Abundance Therapy Center 4221 Wilshire Blvd Ste 170-16 Los Angeles CA 90010-3519 Ph: (213) 441-6780 |
| NPI Number | 1205335445 |
|---|---|
| Provider Enumeration Date | 02/02/2018 |
| Last Update Date | 10/14/2021 |
| Certification Date | 10/14/2021 |
| Medicare PECOS PAC ID | 5890126882 |
|---|---|
| Medicare Enrollment ID | O20200506002781 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205335445 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCSW28582 (California) | Primary |
| 106H00000X | Marriage & Family Therapist | LMFT98291 (California) | Secondary |
| Provider Name | Christine J Chae |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235394735 PECOS PAC ID: 7315193117 Enrollment ID: I20120810000075 |
| Provider Name | Jasmine A Vasquez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093002859 PECOS PAC ID: 1850722521 Enrollment ID: I20200513000745 |
| Provider Name | Blaine Mcfadden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396163366 PECOS PAC ID: 0749611036 Enrollment ID: I20200521001210 |
| Provider Name | Jill Lynn Gottlieb |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811085467 PECOS PAC ID: 3779991062 Enrollment ID: I20210427000981 |
| Provider Name | Jenna H Bekier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992287866 PECOS PAC ID: 3072999465 Enrollment ID: I20221010000490 |
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