Healthcare Provider Details

I. General information

NPI: 1528317955
Provider Name (Legal Business Name): BEACH CITIES PSYCHOLOGICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 PACIFIC COAST HWY SUITE 325
HERMOSA BEACH CA
90254-2225
US

IV. Provider business mailing address

934 HERMOSA AVE SUITE 11
HERMOSA BEACH CA
90254-4122
US

V. Phone/Fax

Practice location:
  • Phone: 310-746-5929
  • Fax: 310-379-6838
Mailing address:
  • Phone: 310-746-5929
  • Fax: 310-388-1268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY22294
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number70014
License Number StateCA

VIII. Authorized Official

Name: DR. SHELLEY K SOMMERFELDT
Title or Position: OWNER
Credential: PSY.D.
Phone: 310-746-5929