Healthcare Provider Details

I. General information

NPI: 1164814174
Provider Name (Legal Business Name): THE CHICAGO SCHOOL OF PROFESSIONAL PSYCHOLOGY COUNSELING CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 WESTWOOD BLVD SUITE 330
LOS ANGELES CA
90025-4650
US

IV. Provider business mailing address

1990 WESTWOOD BLVD SUITE 330
LOS ANGELES CA
90025-4650
US

V. Phone/Fax

Practice location:
  • Phone: 310-481-5900
  • Fax:
Mailing address:
  • Phone: 310-481-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAUN BAKER
Title or Position: AVP TRAINING AND LICENSURE AFFAIRS
Credential: PH.D.
Phone: 310-481-5900