Healthcare Provider Details

I. General information

NPI: 1679169627
Provider Name (Legal Business Name): TELESCOPE PSYCHOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16200 VENTURA BLVD STE 403
ENCINO CA
91436-4692
US

IV. Provider business mailing address

17412 VENTURA BLVD STE 29
ENCINO CA
91316-3827
US

V. Phone/Fax

Practice location:
  • Phone: 818-336-1786
  • Fax:
Mailing address:
  • Phone: 818-581-9995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID SOLOMON
Title or Position: OWNER
Credential: PSY.D
Phone: 818-336-1786