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General NPI Number Information
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NPI Number | 1689439804
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Entity Type | Organization
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Legal Business Name | CENTURY PSYCHOLOGY GROUP INC
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Dates
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Enumeration Date | 02/16/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 416 N BEDFORD DR STE 208
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4317
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Country | US
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Telephone | 213-342-1026
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Fax |
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Provider Business Mailing Address
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Address Line | 416 N BEDFORD DR STE 208
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4317
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Country | US
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Telephone | 213-342-1026
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | SHANNON DANESHRAD
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Credential | PSY.D.
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Telephone | 818-633-9167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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