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General NPI Number Information
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NPI Number | 1265212054
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Entity Type | Organization
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Legal Business Name | PRAXIS: A PSYCHOTHERAPY PRACTICE
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Dates
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Enumeration Date | 09/29/2023
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 71 W SIERRA MADRE BLVD
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City | SIERRA MADRE
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State | CA
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Zip | 91024-2462
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Country | US
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Telephone | 626-578-5803
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Fax |
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Provider Business Mailing Address
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Address Line | 71 W SIERRA MADRE BLVD
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City | SIERRA MADRE
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State | CA
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Zip | 91024-2462
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Country | US
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Telephone | 626-578-5803
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR/CLINICAL DIRECTOR
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Name | RYAN FORSELL
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Credential | LMFT
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Telephone | 626-578-5803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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