Healthcare Provider Details

I. General information

NPI: 1336609189
Provider Name (Legal Business Name): PSYCHOTHERAPY CENTER FOR HEALING AND PERSONAL GROWTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S. BARINGTON AVE SUITE 222
LOS ANGELES CA
90025
US

IV. Provider business mailing address

2001 S. BARINGTON AVE SUITE 222
LOS ANGELES CA
90025
US

V. Phone/Fax

Practice location:
  • Phone: 310-991-9616
  • Fax:
Mailing address:
  • Phone: 310-991-9616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. RONIT FARZAM
Title or Position: PSYCHOLOGIST
Credential: PHD.
Phone: 310-991-9616