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General NPI Number Information
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NPI Number | 1962967372
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Entity Type | Organization
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Legal Business Name | SANTA MONICA THERAPY, A PSYCHOLOGY CORPORATION
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Dates
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Enumeration Date | 02/11/2019
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 3301 OCEAN PARK BLVD STE 210
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City | SANTA MONICA
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State | CA
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Zip | 90405-3230
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Country | US
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Telephone | 310-845-6720
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Fax |
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Provider Business Mailing Address
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Address Line | 3301 OCEAN PARK BLVD STE 210
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City | SANTA MONICA
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State | CA
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Zip | 90405-3230
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY WONG
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Credential | PH.D.
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Telephone | 310-845-6720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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