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General NPI Number Information
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NPI Number | 1770922817
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Entity Type | Organization
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Legal Business Name | ATOMIC SHRINK PSYCHOLOGY, INC
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 40585 BIG BEAR BLVD SUITE 2
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City | BIG BEAR LAKE
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State | CA
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Zip | 92315
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Country | US
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Telephone | 909-255-5351
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Fax | 800-976-0803
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Provider Business Mailing Address
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Address Line | 17328 VENTURA BLVD SUITE 134
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City | ENCINO
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State | CA
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Zip | 91316-3904
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Country | US
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Telephone | 818-481-6581
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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. PATRICIA KEIKO MASUDA-STORY
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Credential | PSYD.
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Telephone | 818-481-6581
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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 | PSY20385
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License Number State | CA
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