Healthcare Provider Details

I. General information

NPI: 1083538532
Provider Name (Legal Business Name): PHOENIX MENTAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 S BEVERLY GLEN BLVD
LOS ANGELES CA
90025-6048
US

IV. Provider business mailing address

10000 WASHINGTON BLVD
CULVER CITY CA
90232-2781
US

V. Phone/Fax

Practice location:
  • Phone: 323-370-4917
  • Fax: 323-372-3127
Mailing address:
  • Phone: 323-370-4917
  • Fax: 323-372-3127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MEAGAN VICTORIA JEAN PRUDEN
Title or Position: OWNER
Credential: MSN, PMHNP-BC
Phone: 323-370-4917