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General NPI Number Information
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NPI Number | 1134418056
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Entity Type | Organization
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Legal Business Name | HOLLYWOOD PSYCHOTHERAPY AND COUNSELING CENTER, INC
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 3744 W SUNSET BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90026-1528
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Country | US
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Telephone | 323-356-9993
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Fax |
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Provider Business Mailing Address
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Address Line | 2520 APOLLO DR
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City | LOS ANGELES
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State | CA
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Zip | 90046-1630
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Country | US
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Telephone | 323-356-9993
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Fax |
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Authorized Official
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Title or Position | PRESEDENT
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Name | DR. BIANA PREM
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Credential | PSY.D
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Telephone | 323-356-9993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY19067
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License Number State | CA
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