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General NPI Number Information
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NPI Number | 1760194138
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Entity Type | Organization
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Legal Business Name | DR. TAMALA BLACK AND ASSOCIATES
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 3645 S MUIRFIELD RD
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City | LOS ANGELES
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State | CA
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Zip | 90016-5717
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Country | US
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Telephone | 424-209-8053
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Fax |
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Provider Business Mailing Address
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Address Line | 6695 GREEN VALLEY CIR UNIT 2822
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City | CULVER CITY
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State | CA
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Zip | 90230-7024
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Country | US
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Telephone | 424-209-8053
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Fax |
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Authorized Official
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Title or Position | OWNER/ THERAPIST
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Name | TAMALA BLACK
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Credential | PSY.D., LMFT 115219
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Telephone | 424-209-8053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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