Healthcare Provider Details

I. General information

NPI: 1083202352
Provider Name (Legal Business Name): THE CONSCIOUS LYFE PSYCHOLOGICAL SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 N CAMDEN DR FL 4
BEVERLY HILLS CA
90210-4408
US

IV. Provider business mailing address

5132 MAPLEWOOD AVE APT 103
LOS ANGELES CA
90004-1583
US

V. Phone/Fax

Practice location:
  • Phone: 424-285-3547
  • Fax:
Mailing address:
  • Phone: 714-402-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. INDHUSHREE RAJAN
Title or Position: CEO/CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 424-285-3547