Healthcare Provider Details

I. General information

NPI: 1568752509
Provider Name (Legal Business Name): K&A PSYCHOLOGICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 AVENIDA DE CORTEZ 1302 AVENIDA DE CORTEZ
PACIFIC PALISADES CA
90272-2123
US

IV. Provider business mailing address

1302 AVENIDA DE CORTEZ 1302 AVENIDA DE CORTEZ
PACIFIC PALISADES CA
90272-2123
US

V. Phone/Fax

Practice location:
  • Phone: 310-387-4119
  • Fax:
Mailing address:
  • Phone: 310-387-4119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPSY16858
License Number StateCA

VIII. Authorized Official

Name: DR. AHMAD REZA RIAHINEJAD
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 310-387-4119