MEDICARE: EXECUTIVE MENTAL HEALTH, 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	101YM0800X	Mental Health Counselor	PSY14872	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275670036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXECUTIVE MENTAL HEALTH, INC.

Provider Business Mailing Address
First Line	:	11835 W OLYMPIC BLVD STE 1270E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-5001
Country	:	US
Telephone Number	:	310-273-4843
Fax Number	:	310-273-5056

Provider Business Practice Location Address
First Line	:	11835 W OLYMPIC BLVD STE 1270E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-5001
Country	:	US
Telephone Number	:	310-273-4843
Fax Number	:	310-273-5056

Authorized Official
Title or Position	:	PRESIDENT/ OWNER
Name	:	DR. ARI DAVID KALECHSTEIN
Credential	:	PH.D
Telephone Number	:	310-273-4843

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	03/24/2023

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