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NPI 1043131873

NPI 1043131873 : SOMA CENTER PSYCH LLC : WEST HOLLYWOOD, CA

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General NPI Number Information
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    NPI Number           |    1043131873
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    Entity Type          |    Organization 
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    Legal Business Name  |    SOMA CENTER PSYCH LLC 
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Dates
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    Enumeration Date     |    07/25/2026
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    Last Update Date     |    07/25/2026
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Provider Practice Location Address
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    Address Line         |    8605 SANTA MONICA BLVD # 109372 
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    City                 |    WEST HOLLYWOOD
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    State                |    CA
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    Zip                  |    90069-4109
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    Country              |    US
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    Telephone            |    805-749-0016
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    8605 SANTA MONICA BLVD # 109372 
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    City                 |    WEST HOLLYWOOD
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    State                |    CA
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    Zip                  |    90069-4109
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    Country              |    US
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    Telephone            |    805-749-0016
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    Fax                  |    
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Authorized Official
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    Title or Position    |    PSYCHOTHERAPIST/ OWNER
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    Name                 |     KRISTY  LONG 
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    Credential           |    LMFT
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    Telephone            |    707-816-1765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    261QM0801X
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    Taxonomy Name        |    Mental Health Clinic/Center (Including Community Mental Health Center)
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    License Number       |    
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    License Number State |    
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