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General NPI Number Information
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NPI Number | 1285182378
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Entity Type | Organization
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Legal Business Name | AIM FOR BREAKTHROUGH
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Dates
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Enumeration Date | 09/17/2016
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Last Update Date | 09/17/2016
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Provider Practice Location Address
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Address Line | 15335 MORRISON ST SUITE 315
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1513
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Country | US
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Telephone | 818-985-1211
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Fax |
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Provider Business Mailing Address
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Address Line | 15335 MORRISON ST SUITE 315
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1513
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED PSYCHOLOGIST
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Name | AUDREY DAVIDHEISER
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Credential | PHD
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Telephone | 818-985-1211
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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 | PSY22815
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License Number State | CA
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