Healthcare Provider Details

I. General information

NPI: 1477806818
Provider Name (Legal Business Name): JOHN GEIRLAND PH.D. PSYCHOTHERAPY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 W RIVERSIDE DR STE 305
BURBANK CA
91505-4048
US

IV. Provider business mailing address

4335 BECK AVE
STUDIO CITY CA
91604-2806
US

V. Phone/Fax

Practice location:
  • Phone: 747-333-8148
  • Fax:
Mailing address:
  • Phone: 747-333-8148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY25197
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY25197
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY25197
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY25197
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN GUIDO GEIRLAND
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 747-333-8148