Healthcare Provider Details

I. General information

NPI: 1558808725
Provider Name (Legal Business Name): DR. IHLE AND ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4137 E 7TH ST
LONG BEACH CA
90804-5311
US

IV. Provider business mailing address

4143 LEVELSIDE AVE
LAKEWOOD CA
90712-4019
US

V. Phone/Fax

Practice location:
  • Phone: 562-433-7652
  • Fax: 562-433-8152
Mailing address:
  • Phone: 562-477-4765
  • Fax: 562-433-8152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY13704
License Number StateCA

VIII. Authorized Official

Name: DR. HOLLY A. IHLE
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 562-477-4765