MEDICARE: THE CENTER FOR NEUROTHERAPY

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	251S00000X	Community/Behavioral Health Agency	PSY144313	CA

General Provider Information

NPI Number	:	1518130905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CENTER FOR NEUROTHERAPY

Provider Business Mailing Address
First Line	:	3330 BARHAM BOULEVARD
Second Line	:	SUITE 101-102
City	:	LOS ANGELES
State	:	CA
Zip	:	90068
Country	:	US
Telephone Number	:	323-512-7150
Fax Number	:	323-512-2041

Provider Business Practice Location Address
First Line	:	3330 BARHAM BLVD
Second Line	:	SUITE 101-102
City	:	LOS ANGELES
State	:	CA
Zip	:	90068-1400
Country	:	US
Telephone Number	:	323-512-7150
Fax Number	:	323-512-2041

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PERRI W JOHNSON
Credential	:	PH.D.
Telephone Number	:	323-512-7150

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	04/08/2008

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Directions to “THE CENTER FOR NEUROTHERAPY ” Practice Location

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