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General NPI Number Information
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NPI Number | 1609736933
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Entity Type | Organization
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Legal Business Name | DIVINE HEALTH PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 11/18/2025
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 3780 KILROY AIRPORT WAY STE 200
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City | LONG BEACH
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State | CA
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Zip | 90806-2458
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Country | US
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Telephone | 323-571-7855
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Fax |
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Provider Business Mailing Address
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Address Line | 11728 205TH ST UNIT 3
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City | LAKEWOOD
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State | CA
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Zip | 90715-3401
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Country | US
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Telephone | 323-571-7855
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Fax |
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Authorized Official
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Title or Position | DNP
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Name | FUTURE OGBEBOR
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Credential |
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Telephone | 323-571-7855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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