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General NPI Number Information
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NPI Number | 1306630587
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Entity Type | Organization
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Legal Business Name | SLO PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 901 OAK PARK BLVD STE 202
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City | PISMO BEACH
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State | CA
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Zip | 93449-3410
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Country | US
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Telephone | 805-316-1410
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 565
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City | PISMO BEACH
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State | CA
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Zip | 93448-0565
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Country | US
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Telephone | 805-316-1410
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. MIRIAM BURLAKOVSKY
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Credential | LEP#4368, BCBA
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Telephone | 805-316-1410
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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