Healthcare Provider Details

I. General information

NPI: 1194439737
Provider Name (Legal Business Name): LA PSYCHOTHERAPY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8075 W 3RD ST STE 306
LOS ANGELES CA
90048-4334
US

IV. Provider business mailing address

8075 W 3RD ST STE 306
LOS ANGELES CA
90048-4334
US

V. Phone/Fax

Practice location:
  • Phone: 323-617-3913
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VANESSA KATZ
Title or Position: OWNER, CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 323-617-3913