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General NPI Number Information
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NPI Number | 1669395810
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Entity Type | Organization
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Legal Business Name | ADVANCED MINDS A PROFESSIONAL PSYCHOLOGICAL CORPORATION
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Dates
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Enumeration Date | 08/04/2026
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Last Update Date | 08/04/2026
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Provider Practice Location Address
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Address Line | 1180 S BEVERLY DR STE 612
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City | LOS ANGELES
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State | CA
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Zip | 90035-1158
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Country | US
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Telephone | 310-361-0771
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Fax |
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Provider Business Mailing Address
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Address Line | 1180 S BEVERLY DR STE 612
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City | LOS ANGELES
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State | CA
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Zip | 90035-1158
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Country | US
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Telephone | 310-361-0771
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEXANDER GANTMAN
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Credential | PSY.D.
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Telephone | 323-547-6760
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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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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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