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General NPI Number Information
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NPI Number | 1407497985
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Entity Type | Organization
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Legal Business Name | PRIME PSYCHOLOGICAL SERVICES INC
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Dates
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Enumeration Date | 10/04/2019
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Last Update Date | 10/04/2019
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Provider Practice Location Address
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Address Line | 3727 W 6TH ST STE 614
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City | LOS ANGELES
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State | CA
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Zip | 90020-5111
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Country | US
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Telephone | 714-293-0123
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Fax | 888-824-3727
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Provider Business Mailing Address
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Address Line | 3727 W 6TH ST STE 614
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City | LOS ANGELES
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State | CA
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Zip | 90020-5111
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Country | US
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Telephone | 714-293-0123
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Fax | 888-824-3727
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Authorized Official
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Title or Position | CEO
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Name | DR. JUSTIN CHOE
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Credential | PSYCHOLOGIST
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Telephone | 713-293-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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