Healthcare Provider Details

I. General information

NPI: 1669134060
Provider Name (Legal Business Name): ONE BH PSYCHOLOGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9008 CASHIO ST
LOS ANGELES CA
90035-3310
US

IV. Provider business mailing address

5001 WILSHIRE BLVD STE 112
LOS ANGELES CA
90036-6106
US

V. Phone/Fax

Practice location:
  • Phone: 805-220-4330
  • Fax: 310-300-0491
Mailing address:
  • Phone: 805-220-4330
  • Fax: 310-300-0491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. YEHUDA GERTEL
Title or Position: OWNER
Credential: PSYD
Phone: 52-204-3308