MEDICARE: FAMILY PSYCHOLOGICAL 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
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1881746733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PSYCHOLOGICAL SERVICES INC

Provider Business Mailing Address
First Line	:	30495 CANWOOD ST STE 101
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4331
Country	:	US
Telephone Number	:	818-707-7366
Fax Number	:	818-306-5836

Provider Business Practice Location Address
First Line	:	30495 CANWOOD ST STE 101
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4331
Country	:	US
Telephone Number	:	818-707-7366
Fax Number	:	818-306-5836

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KIM B BARRUS, PH.D.
Credential	:	PH.D.
Telephone Number	:	818-707-7366

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	01/14/2025

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