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General NPI Number Information
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NPI Number | 1689684607
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Entity Type | Organization
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Legal Business Name | CULVER CITY PSYCHOLOGICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5000 OVERLAND AVE 8
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City | CULVER CITY
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State | CA
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Zip | 90230-4995
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Country | US
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Telephone | 310-838-2738
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Fax | 310-838-2729
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Provider Business Mailing Address
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Address Line | PO BOX 2900
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City | CULVER CITY
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State | CA
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Zip | 90231-2900
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Country | US
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Telephone | 310-838-2738
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Fax | 310-838-2729
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VALERIE WITHERSPOON
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Credential | PHD, RN, CNS
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Telephone | 310-838-2738
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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 | PSY13838
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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 | PSY15514
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License Number State | CA
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