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General NPI Number Information
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NPI Number | 1528317955
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Entity Type | Organization
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Legal Business Name | BEACH CITIES PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | 2615 PACIFIC COAST HWY SUITE 325
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-2225
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Country | US
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Telephone | 310-746-5929
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Fax | 310-379-6838
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Provider Business Mailing Address
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Address Line | 934 HERMOSA AVE SUITE 11
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-4122
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Country | US
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Telephone | 310-746-5929
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Fax | 310-388-1268
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHELLEY K SOMMERFELDT
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Credential | PSY.D.
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Telephone | 310-746-5929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 70014
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY22294
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License Number State | CA
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