Healthcare Provider Details

I. General information

NPI: 1245778620
Provider Name (Legal Business Name): SEAN THEUS FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 01/11/2025
Certification Date: 01/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11150 WEST OLYMPIC BLVD 760
LOS ANGELES CA
90064
US

IV. Provider business mailing address

20955 DEVONSHIRE ST STE B
CHATSWORTH CA
91311-2313
US

V. Phone/Fax

Practice location:
  • Phone: 424-307-9504
  • Fax:
Mailing address:
  • Phone: 661-899-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008284
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP9885
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95008284
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95008284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: