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General NPI Number Information
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NPI Number | 1932651817
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Entity Type | Organization
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Legal Business Name | SILVER LAKE PSYCHOLOGY INC.
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Dates
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Enumeration Date | 10/26/2016
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 4325 W SUNSET BLVD 206
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City | LOS ANGELES
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State | CA
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Zip | 90029-2174
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Country | US
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Telephone | 310-388-7983
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Fax |
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Provider Business Mailing Address
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Address Line | 4325 W SUNSET BLVD 206
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City | LOS ANGELES
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State | CA
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Zip | 90029-2174
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Country | US
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Telephone | 310-388-7983
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRANDY DUNN
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Credential | PSYD
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Telephone | 310-388-7983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 22512
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License Number State | CA
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