MEDICARE: LOS ANGELES THERAPY COLLECTIVE, LICENSED CLINICAL SOCIAL WORKERS, 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1477281434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS ANGELES THERAPY COLLECTIVE, LICENSED CLINICAL SOCIAL WORKERS, INC.

Provider Business Mailing Address
First Line	:	1920 HILLHURST AVE # 1066
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-2712
Country	:	US
Telephone Number	:	323-305-9933
Fax Number	:

Provider Business Practice Location Address
First Line	:	2453 LOMA VISTA ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-3404
Country	:	US
Telephone Number	:	323-305-9933
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KAYTLIN SIROUNIAN
Credential	:	LCSW
Telephone Number	:	323-305-9933

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	08/09/2022

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