Healthcare Provider Details

I. General information

NPI: 1669996328
Provider Name (Legal Business Name): THERAPY ON DEMAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5455 WILSHIRE BLVD STE 1010
LOS ANGELES CA
90036-4237
US

IV. Provider business mailing address

5455 WILSHIRE BLVD STE 1010
LOS ANGELES CA
90036-4237
US

V. Phone/Fax

Practice location:
  • Phone: 503-200-0944
  • Fax:
Mailing address:
  • Phone: 503-200-0944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER HOLLER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 503-200-0944