Healthcare Provider Details

I. General information

NPI: 1053467167
Provider Name (Legal Business Name): CENTER FOR BEHAVIOR MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 COLIMA RD STE 206
WHITTIER CA
90605-1814
US

IV. Provider business mailing address

9200 COLIMA RD STE 206
WHITTIER CA
90605-1814
US

V. Phone/Fax

Practice location:
  • Phone: 562-789-9908
  • Fax:
Mailing address:
  • Phone: 562-789-9908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberCP6253
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL E HARRIS
Title or Position: ADMINISTRATOR
Credential: PHD
Phone: 562-945-5454