MEDICARE: WEEKEND THERAPY PSYCHOLOGICAL SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TC1900X	Counseling Psychologist
2	101YM0800X	Mental Health Counselor
3	103TF0200X	Forensic Psychologist
4	103T00000X	Psychologist
5	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1003695362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEEKEND THERAPY PSYCHOLOGICAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	1301 N BROADWAY STE 32424
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-1408
Country	:	US
Telephone Number	:	805-225-4446
Fax Number	:	805-273-0206

Provider Business Practice Location Address
First Line	:	1301 N BROADWAY STE 32424
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-1408
Country	:	US
Telephone Number	:	805-225-4446
Fax Number	:	805-273-0206

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NICHOLAS KEITH BENNETT
Credential	:
Telephone Number	:	805-203-6673

Provider Enumeration Date	:	09/26/2023
Last Update Date	:	12/09/2025

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