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General NPI Number Information
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NPI Number | 1942507694
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Entity Type | Organization
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Legal Business Name | ENGAGE PSYCHOLOGICAL SERVICES INC
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 02/15/2011
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Provider Practice Location Address
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Address Line | 650 HAMPSHIRE RD SUITE 200
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-2510
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Country | US
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Telephone | 805-497-0605
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Fax | 805-371-4862
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Provider Business Mailing Address
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Address Line | 650 HAMPSHIRE RD SUITE 200
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-2510
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Country | US
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Telephone | 805-497-0605
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Fax | 805-371-4862
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Authorized Official
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Title or Position | C.E.O
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Name | MR. TREVOR REYNOLDS
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Credential | M.F.T.
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Telephone | 80549700605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MFC41847
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License Number State | CA
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