Healthcare Provider Details

I. General information

NPI: 1508698598
Provider Name (Legal Business Name): LOS ANGELES INTEGRATIVE MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2024
Last Update Date: 08/17/2024
Certification Date: 08/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 WESTWOOD BLVD STE 360
LOS ANGELES CA
90025-4650
US

IV. Provider business mailing address

1990 WESTWOOD BLVD STE 360
LOS ANGELES CA
90025-4650
US

V. Phone/Fax

Practice location:
  • Phone: 424-222-5257
  • Fax:
Mailing address:
  • Phone: 424-222-5257
  • 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 Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ADAM STOKER
Title or Position: OWNER/LICENSED PSYCHOLOGIST
Credential: PHD
Phone: 424-222-5257