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General NPI Number Information
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NPI Number | 1245787340
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Entity Type | Organization
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Legal Business Name | KATIE ENNEY PSYCHOLOGIST INC
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 2898 ROWENA AVE SUITE 206
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City | LOS ANGELES
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State | CA
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Zip | 90039-2020
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Country | US
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Telephone | 818-583-7134
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Fax |
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Provider Business Mailing Address
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Address Line | 1941 NEW YORK DR
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City | ALTADENA
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State | CA
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Zip | 91001-3425
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Country | US
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Telephone | 818-583-7134
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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. KATIE ENNEY
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Credential | PSY.D.
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Telephone | 818-583-7134
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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 | PSY28571
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License Number State | CA
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