Healthcare Provider Details

I. General information

NPI: 1184256109
Provider Name (Legal Business Name): PRT PSYCHOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 CARNEGIE LN
REDONDO BEACH CA
90278-5602
US

IV. Provider business mailing address

440 N BARRANCA AVE # 1104
COVINA CA
91723-1722
US

V. Phone/Fax

Practice location:
  • Phone: 323-366-8067
  • Fax: 323-488-9291
Mailing address:
  • Phone: 323-366-8067
  • Fax: 323-488-9291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL-ROY TAYLOR
Title or Position: PRESIDENT
Credential: PHD
Phone: 323-366-8067