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General NPI Number Information
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NPI Number | 1720433527
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Entity Type | Organization
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Legal Business Name | THE BLUE CLINIC: A PSYCHOLOGY PRACTICE
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Dates
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Enumeration Date | 04/29/2016
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 633 W 5TH ST 2600
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City | LOS ANGELES
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State | CA
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Zip | 90071-2005
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Country | US
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Telephone | 213-290-4183
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Fax |
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Provider Business Mailing Address
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Address Line | 633 W 5TH ST 2600
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City | LOS ANGELES
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State | CA
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Zip | 90071-2005
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Country | US
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Telephone | 213-290-4183
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. ADAOBI I ANYEJI
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Credential | PHD
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Telephone | 213-290-4183
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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 | PSY26828
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License Number State | CA
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