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NPI Code Detail

MEDICARE: PRO PSYCH SERVICES INC

MEDICARE: PRO PSYCH SERVICES INC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1043224959
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRO PSYCH SERVICES INC
Provider Business Mailing Address
First Line : 12501 CHANDLER BLVD STE 102
Second Line :
City : VALLEY VILLAGE
State : CA
Zip : 91607-1955
Country : US
Telephone Number : 818-821-6012
Fax Number : 818-821-6014
Provider Business Practice Location Address
First Line : 12501 CHANDLER BLVD STE 102
Second Line :
City : VALLEY VILLAGE
State : CA
Zip : 91607-1955
Country : US
Telephone Number : 818-821-6012
Fax Number : 818-821-6014
Authorized Official
Title or Position : CEO
Name : RONALD LOUIS KAUFMAN
Credential : PSYD
Telephone Number : 818-821-6012
Provider Enumeration Date : 07/28/2006
Last Update Date : 04/30/2019

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Directions to “PRO PSYCH SERVICES INC ” Practice Location

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