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General NPI Number Information
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NPI Number | 1407159791
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Entity Type | Organization
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Legal Business Name | GREENWAY CLINIC OF PSYCHOLOGICAL SERVICES INC
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 01/18/2012
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Provider Practice Location Address
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Address Line | 3322 BARHAM BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90068-1404
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Country | US
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Telephone | 323-851-3200
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Fax | 323-851-3215
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Provider Business Mailing Address
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Address Line | PO BOX 55458
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City | SHERMAN OAKS
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State | CA
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Zip | 91413-0458
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Country | US
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Telephone | 323-851-3200
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Fax | 323-851-3215
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Authorized Official
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Title or Position | CEO
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Name | SOOKYUNG K. CHANG
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Credential | PHD
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Telephone | 323-851-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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