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General NPI Number Information
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NPI Number | 1417332545
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Entity Type | Organization
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Legal Business Name | GOLDEN STATE NEUROPLASTICS
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 757 RIDGESIDE DR
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City | MONROVIA
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State | CA
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Zip | 91016-1721
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Country | US
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Telephone | 213-260-0605
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Fax | 888-789-9773
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Provider Business Mailing Address
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Address Line | 1910 WEST FARLINGTON
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City | WEST COVINA
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State | CA
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Zip | 91790
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Country | US
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Telephone | 310-863-6199
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Fax | 888-789-9773
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Authorized Official
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Title or Position | CEO
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Name | DR. CHRISTOPHER BARTLETT FRANKLIN
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Credential | PSY.D.
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Telephone | 310-863-6199
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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 | PSY24447
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License Number State | CA
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