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General NPI Number Information
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NPI Number | 1427504281
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC INTEGRATIVE PSYCHOTHERAPY CLINIC, INC.
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 2171 14TH AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94116-1840
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Country | US
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Telephone | 323-445-8900
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Fax | 323-345-5778
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Provider Business Mailing Address
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Address Line | 14320 VENTURA BLVD # 1129
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-2717
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Country | US
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Telephone | 323-445-8900
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Fax | 323-345-5778
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALAN B GOODWIN
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Credential | PH.D.
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Telephone | 323-445-8900
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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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