Healthcare Provider Details

I. General information

NPI: 1275604274
Provider Name (Legal Business Name): CORTEX BEHAVIORAL HEALTH, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17337 VENTURA BLVD STE 206
ENCINO CA
91316-4926
US

IV. Provider business mailing address

17337 VENTURA BLVD STE 206
ENCINO CA
91316-4926
US

V. Phone/Fax

Practice location:
  • Phone: 818-995-4477
  • Fax: 818-995-4171
Mailing address:
  • Phone: 818-995-4477
  • Fax: 818-995-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY13806
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY13806
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY10973
License Number StateCA

VIII. Authorized Official

Name: DR. ELLEN SHIRMAN
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 818-995-4477