Healthcare Provider Details

I. General information

NPI: 1205214087
Provider Name (Legal Business Name): NEURO HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8383 WILSHIRE BLVD SUITE #800
BEVERLY HILLS CA
90211-2425
US

IV. Provider business mailing address

1454 S CREST DR
LOS ANGELES CA
90035-3312
US

V. Phone/Fax

Practice location:
  • Phone: 323-456-8686
  • Fax:
Mailing address:
  • Phone: 310-490-9899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY26943
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26943
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY26943
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY26943
License Number StateCA

VIII. Authorized Official

Name: DR. KATY D GAINES
Title or Position: CEO
Credential: PHD
Phone: 323-456-8686