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General NPI Number Information
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NPI Number | 1265840482
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Entity Type | Organization
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Legal Business Name | PSYCHCOUNSEL LLC
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 07/31/2014
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Provider Practice Location Address
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Address Line | 1112 OCEAN DR SUITE 102
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-5448
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Country | US
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Telephone | 310-882-6805
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Fax |
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Provider Business Mailing Address
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Address Line | 12001 VENTURA PL SUITE 203
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City | STUDIO CITY
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State | CA
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Zip | 91604-2626
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Country | US
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Telephone | 310-882-6805
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. REBECCA ROY
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Credential | PH.D., LMFT
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Telephone | 310-882-6805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 45901
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License Number State | CA
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