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General NPI Number Information
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NPI Number | 1043523632
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Entity Type | Organization
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Legal Business Name | OF ONE MIND TEENWORK & FAMILY THERAPY, APC
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Dates
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Enumeration Date | 07/23/2010
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Last Update Date | 07/23/2010
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Provider Practice Location Address
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Address Line | 2001 S BARRINGTON AVE STE 300
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City | LOS ANGELES
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State | CA
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Zip | 90025-5379
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Country | US
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Telephone | 310-479-9065
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Fax | 310-479-0441
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Provider Business Mailing Address
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Address Line | 2001 S BARRINGTON AVE STE 300
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City | LOS ANGELES
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State | CA
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Zip | 90025-5379
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Country | US
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Telephone | 310-479-9065
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Fax | 310-479-0441
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD BRUCE COHEN
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Credential | MFT
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Telephone | 310-479-9065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 15185
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License Number State | CA
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