Healthcare Provider Details

I. General information

NPI: 1801821830
Provider Name (Legal Business Name): LA VIE PSYCHOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 SIERRA MADRE VILLA AVE SUITE 110
PASADENA CA
91107-2013
US

IV. Provider business mailing address

650 SIERRA MADRE VILLA AVE SUITE 110
PASADENA CA
91107-2013
US

V. Phone/Fax

Practice location:
  • Phone: 626-351-9616
  • Fax: 626-351-9493
Mailing address:
  • Phone: 626-351-9616
  • Fax: 626-351-9493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY9219
License Number StateCA

VIII. Authorized Official

Name: DR. MARK W. BAKER
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 626-351-9616