MEDICARE: INNER LIGHT PSYCHOLOGICAL INSIGHTS PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	103TB0200X	Cognitive & Behavioral Psychologist
3	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1598699282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER LIGHT PSYCHOLOGICAL INSIGHTS PC

Provider Business Mailing Address
First Line	:	1301 N BROADWAY STE 42957
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-1408
Country	:	US
Telephone Number	:	424-655-3450
Fax Number	:	424-788-5572

Provider Business Practice Location Address
First Line	:	1301 N BROADWAY STE 42957
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-1408
Country	:	US
Telephone Number	:	424-655-3450
Fax Number	:	424-788-5572

Authorized Official
Title or Position	:	CO-CEO
Name	:	EMILY J CAMPBELL
Credential	:	PHD
Telephone Number	:	424-655-3450

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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