Healthcare Provider Details

I. General information

NPI: 1639477664
Provider Name (Legal Business Name): PSLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 WILSHIRE BLVD SUITE 306
BEVERLY HILLS CA
90212-3213
US

IV. Provider business mailing address

9300 WILSHIRE BLVD SUITE 306
BEVERLY HILLS CA
90212-3213
US

V. Phone/Fax

Practice location:
  • Phone: 310-424-8516
  • Fax: 310-276-4010
Mailing address:
  • Phone: 310-424-8516
  • Fax: 310-276-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 44338
License Number StateCA

VIII. Authorized Official

Name: THOMAS J PARISI JR.
Title or Position: PSYCHOTHERAPIST
Credential: M.F.T.
Phone: 310-424-8516