Healthcare Provider Details

I. General information

NPI: 1245394121
Provider Name (Legal Business Name): COUNSELING CENTER OF SANTA MONICA - A PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 9TH ST
SANTA MONICA CA
90401-1803
US

IV. Provider business mailing address

1321 9TH ST
SANTA MONICA CA
90401-1803
US

V. Phone/Fax

Practice location:
  • Phone: 310-477-6000
  • Fax: 310-477-0327
Mailing address:
  • Phone: 310-477-6000
  • Fax: 310-477-0327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY 15091
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY 15091
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY 15091
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY 15091
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 15091
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY 15091
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 15091
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License NumberPSY 15091
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY 15091
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY 15091
License Number StateCA
# 11
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY 15091
License Number StateCA
# 12
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 15091
License Number StateCA

VIII. Authorized Official

Name: DR. REUBEN VAISMAN-TZACHOR
Title or Position: PRESIDENT - OWNER
Credential: PH.D.
Phone: 310-477-6000