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General NPI Number Information
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NPI Number | 1235761099
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Entity Type | Organization
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Legal Business Name | BRAIN-HEART CONNECTION, A PSYCHOLOGICAL SERVICES CORPORATION
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 420 1/2 N LARCHMONT BLVD STE 2
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City | LOS ANGELES
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State | CA
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Zip | 90004-3014
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Country | US
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Telephone | 213-986-6181
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Fax |
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Provider Business Mailing Address
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Address Line | 1758 W SILVER LAKE DR
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City | LOS ANGELES
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State | CA
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Zip | 90026-1232
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Country | US
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Telephone | 310-883-5431
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAURA B. O'CONNOR
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Credential | PSY.D.
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Telephone | 213-986-6181
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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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