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General NPI Number Information
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NPI Number | 1770922916
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Entity Type | Individual
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Provider Name | IRINA KOLL PSY.D
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Gender | Female
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Dates
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Enumeration Date | 06/20/2013
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Last Update Date | 11/16/2021
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Provider Practice Location Address
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Address Line | 12450 VAN NUYS BLVD STE 200
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City | PACOIMA
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State | CA
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Zip | 91331-1393
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Country | US
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Telephone | 818-896-1161
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Fax | 818-896-5069
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Provider Business Mailing Address
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Address Line | 12450 VAN NUYS BLVD STE 200
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City | PACOIMA
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State | CA
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Zip | 91331-1393
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Country | US
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Telephone | 818-896-1161
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Fax | 818-896-5069
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSB94025992
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License Number State | CA
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