Healthcare Provider Details

I. General information

NPI: 1053666024
Provider Name (Legal Business Name): LOS ANGELES FAMILY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22287 MULHOLLAND HWY # 136
CALABASAS CA
91302-5157
US

IV. Provider business mailing address

22287 MULHOLLAND HWY # 136
CALABASAS CA
91302-5157
US

V. Phone/Fax

Practice location:
  • Phone: 818-635-9380
  • Fax:
Mailing address:
  • Phone: 818-635-9380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberBA33452
License Number StateCA

VIII. Authorized Official

Name: MR. CHRISTOPHER JAMES BATHUM
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PHD
Phone: 818-635-9380