MEDICARE: EVIDENCE BASED PSYCHOLOGICAL CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1295591196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVIDENCE BASED PSYCHOLOGICAL CARE, INC

Provider Business Mailing Address
First Line	:	23632 CALABASAS RD STE 201
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-1737
Country	:	US
Telephone Number	:	818-253-1164
Fax Number	:

Provider Business Practice Location Address
First Line	:	23632 CALABASAS RD STE 201
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-1737
Country	:	US
Telephone Number	:	818-253-1164
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CARA J KIFF
Credential	:	PHD
Telephone Number	:	310-770-8866

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	02/27/2024

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