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General NPI Number Information
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NPI Number | 1003135906
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL CARE AND HEALING TREATMENT CENTER
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Dates
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Enumeration Date | 05/18/2010
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Last Update Date | 05/18/2010
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Provider Practice Location Address
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Address Line | 11965 VENICE BLVD SUITE 407
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City | LOS ANGELES
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State | CA
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Zip | 90066-3979
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Country | US
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Telephone | 310-566-7625
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Fax | 310-566-7629
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Provider Business Mailing Address
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Address Line | 11965 VENICE BLVD SUITE 407
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City | LOS ANGELES
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State | CA
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Zip | 90066-3979
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Country | US
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Telephone | 310-566-7625
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Fax | 310-566-7629
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Authorized Official
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Title or Position | EXECUTIVE AND CLINICAL DIRECTOR
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Name | JEFFERY BALL
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Credential | PHD
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Telephone | 310-571-8040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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