Healthcare Provider Details

I. General information

NPI: 1659851053
Provider Name (Legal Business Name): LASEY'S PSYCHOTHERAPY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 E WARDLOW RD
LONG BEACH CA
90807-4833
US

IV. Provider business mailing address

1232 E WARDLOW RD
LONG BEACH CA
90807-4833
US

V. Phone/Fax

Practice location:
  • Phone: 562-205-8846
  • Fax:
Mailing address:
  • Phone: 562-205-8846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCS29611
License Number StateCA

VIII. Authorized Official

Name: MS. MONIQUE LASEY GARY
Title or Position: OWNER
Credential: LCSW
Phone: 562-205-8846