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General NPI Number Information
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NPI Number | 1952023103
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Entity Type | Organization
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Legal Business Name | ELYSIAN PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 3477 WRIGHTWOOD DR
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City | STUDIO CITY
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State | CA
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Zip | 91604-3942
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Country | US
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Telephone | 213-595-3450
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Fax |
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Provider Business Mailing Address
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Address Line | 1211 SUNSET PLAZA DR APT 213
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-1249
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Country | US
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Telephone | 213-595-3450
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | OLGA SKARLATO
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Credential | PSYD
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Telephone | 213-595-3450
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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 |
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License Number State |
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