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General NPI Number Information
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NPI Number | 1780081547
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Entity Type | Organization
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Legal Business Name | RUARK PSYCHOTHERAPY APC
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 3020 CASTLE HEIGHTS AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-2753
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Country | US
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Telephone | 310-837-7979
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Fax |
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Provider Business Mailing Address
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Address Line | 9854 NATIONAL BLVD SUITE 372
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City | LOS ANGELES
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State | CA
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Zip | 90034-2713
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Country | US
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Telephone | 310-837-7979
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL RUARK
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Credential | M.A., M.F.T.
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Telephone | 310-837-7979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT34153
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License Number State | CA
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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 | PSY10329
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License Number State | CA
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