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General NPI Number Information
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NPI Number | 1427246610
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Entity Type | Organization
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Legal Business Name | UCLA, STUDENT PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 221 WESTWOOD PLAZA JOHN WOODEN CENTER WEST
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City | LOS ANGELES
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State | CA
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Zip | 90095-0001
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Country | US
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Telephone | 310-825-0768
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Fax |
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Provider Business Mailing Address
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Address Line | 221 WESTWOOD PLAZA
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City | LOS ANGELES
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State | CA
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Zip | 90095-1556
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Country | US
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Telephone | 310-825-0768
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ELIZABETH GONG-GUY
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Credential | PH.D
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Telephone | 310-825-0768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | LCS 20905
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License Number State | CA
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