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General NPI Number Information
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NPI Number | 1306301593
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Entity Type | Organization
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Legal Business Name | PEAK PSYCHOLOGY INC
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 2211 CORINTH AVE STE 310
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City | LOS ANGELES
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State | CA
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Zip | 90064-1622
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Country | US
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Telephone | 310-781-0187
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Fax |
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Provider Business Mailing Address
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Address Line | 3235 DONALD DOUGLAS LOOP S
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City | SANTA MONICA
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State | CA
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Zip | 90405-3213
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Country | US
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Telephone | 310-271-9660
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSE LAURICELLA
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Credential |
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Telephone | 310-781-0187
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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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