Healthcare Provider Details

I. General information

NPI: 1295615045
Provider Name (Legal Business Name): AUTHENTIC PSYCHOLOGICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 11/09/2025
Certification Date: 11/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10850 WILSHIRE BLVD STE 1150
LOS ANGELES CA
90024-4330
US

IV. Provider business mailing address

9440 SANTA MONICA BLVD STE 301
BEVERLY HILLS CA
90210-4614
US

V. Phone/Fax

Practice location:
  • Phone: 424-268-0471
  • Fax:
Mailing address:
  • Phone: 424-268-0471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN DOLORES
Title or Position: ADMINISTRATOR
Credential:
Phone: 916-385-4849