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General NPI Number Information
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NPI Number | 1003600933
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Entity Type | Organization
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Legal Business Name | BESPOKE THERAPY INC
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 1300 N LAUREL AVE APT 17
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046-4613
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Country | US
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Telephone | 646-374-2827
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Fax |
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Provider Business Mailing Address
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Address Line | 401 W 25TH ST APT 13C
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City | NEW YORK
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State | NY
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Zip | 10001-6575
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACK HAZAN
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Credential |
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Telephone | 917-453-9306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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