Healthcare Provider Details

I. General information

NPI: 1891853461
Provider Name (Legal Business Name): STACI ATKINS PSYD, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 W WASHINGTON BLVD STE 122
LOS ANGELES CA
90066-5176
US

IV. Provider business mailing address

3740 SANTA ROSALIA DR APT 220
LOS ANGELES CA
90008-3623
US

V. Phone/Fax

Practice location:
  • Phone: 424-835-1770
  • Fax:
Mailing address:
  • Phone: 310-895-4267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35327
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 26308
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: