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General NPI Number Information
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NPI Number | 1588248306
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Entity Type | Organization
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Legal Business Name | TRANSFORM PSYCHOTHERAPY APC
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Dates
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Enumeration Date | 05/07/2021
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Last Update Date | 05/07/2021
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Provider Practice Location Address
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Address Line | 1849 SAWTELLE BLVD STE 610
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City | LOS ANGELES
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State | CA
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Zip | 90025-7013
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Country | US
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Telephone | 424-272-1554
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Fax |
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Provider Business Mailing Address
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Address Line | 24 ROSE AVE APT C
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City | VENICE
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State | CA
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Zip | 90291-2457
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Country | US
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Telephone | 626-864-6412
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JUSTIN BARKER
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Credential | PSY.D.
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Telephone | 424-272-1554
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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 |
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License Number State |
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