MEDICARE: HOLLYWOOD PSYCHOTHERAPY AND COUNSELING CENTER, 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
1	103T00000X	Psychologist	PSY19067	CA

General Provider Information

NPI Number	:	1134418056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLYWOOD PSYCHOTHERAPY AND COUNSELING CENTER, INC

Provider Business Mailing Address
First Line	:	2520 APOLLO DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-1630
Country	:	US
Telephone Number	:	323-356-9993
Fax Number	:

Provider Business Practice Location Address
First Line	:	3744 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-1528
Country	:	US
Telephone Number	:	323-356-9993
Fax Number	:

Authorized Official
Title or Position	:	PRESEDENT
Name	:	DR. BIANA PREM
Credential	:	PSY.D
Telephone Number	:	323-356-9993

Provider Enumeration Date	:	03/31/2011
Last Update Date	:	03/31/2011

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