Healthcare Provider Details

I. General information

NPI: 1023510690
Provider Name (Legal Business Name): BEVERLY HILLS PSYCHOTHERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9012 BURTON WAY
BEVERLY HILLS CA
90211-1618
US

IV. Provider business mailing address

324 S BEVERLY DR STE 384
BEVERLY HILLS CA
90212-4801
US

V. Phone/Fax

Practice location:
  • Phone: 888-494-7788
  • Fax:
Mailing address:
  • Phone: 888-494-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number90143
License Number StateCA

VIII. Authorized Official

Name: RON GAD
Title or Position: PRESIDENT
Credential:
Phone: 888-494-7788