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General NPI Number Information
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NPI Number | 1699009753
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Entity Type | Organization
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Legal Business Name | EB PSYCHOTHERAPY, INC
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 2001 S BARRINGTON AVE STE 314
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City | LOS ANGELES
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State | CA
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Zip | 90025-5379
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Country | US
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Telephone | 310-999-9683
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Fax | 213-261-9887
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Provider Business Mailing Address
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Address Line | 2001 S BARRINGTON AVE STE 314
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City | LOS ANGELES
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State | CA
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Zip | 90025-5379
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Country | US
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Telephone | 310-999-9683
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. ELENI BAGOURDI
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Credential |
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Telephone | 310-999-9683
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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 | PSY22542
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License Number State | CA
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