Healthcare Provider Details

I. General information

NPI: 1003695362
Provider Name (Legal Business Name): WEEKEND THERAPY PSYCHOLOGICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N BROADWAY STE 32424
LOS ANGELES CA
90012-1408
US

IV. Provider business mailing address

1301 N BROADWAY STE 32424
LOS ANGELES CA
90012-1408
US

V. Phone/Fax

Practice location:
  • Phone: 805-225-4446
  • Fax: 805-273-0206
Mailing address:
  • Phone: 805-225-4446
  • Fax: 805-273-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS KEITH BENNETT
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 805-203-6673