Healthcare Provider Details

I. General information

NPI: 1043581358
Provider Name (Legal Business Name): WESTSIDE TMS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 W CENTINELA AVE SUITE 378
CULVER CITY CA
90230-6337
US

IV. Provider business mailing address

6101 W CENTINELA AVE SUITE 378
CULVER CITY CA
90230-6337
US

V. Phone/Fax

Practice location:
  • Phone: 310-258-9524
  • Fax:
Mailing address:
  • Phone: 310-258-9524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA SAMPSON
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 310-572-7000