MEDICARE: THE CHICAGO SCHOOL OF PROFESSIONAL PSYCHOLOGY

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	190284AN	CA

General Provider Information

NPI Number	:	1952539736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CHICAGO SCHOOL OF PROFESSIONAL PSYCHOLOGY

Provider Business Mailing Address
First Line	:	1145 GAYLEY AVE.
Second Line	:	THE CHICAGO SCHOOL OF PROFESSIONAL PSYCHOLOGY
City	:	LOS ANGELES
State	:	CA
Zip	:	90024
Country	:	US
Telephone Number	:	310-208-1482
Fax Number	:

Provider Business Practice Location Address
First Line	:	1145 GAYLEY AVE
Second Line	:	SUIE 322
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-3423
Country	:	US
Telephone Number	:	310-208-1482
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. MELODIE SCHAEFER
Credential	:	PSY.D.
Telephone Number	:	310-208-1482

Provider Enumeration Date	:	06/30/2009
Last Update Date	:	06/30/2009

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Directions to “THE CHICAGO SCHOOL OF PROFESSIONAL PSYCHOLOGY ” Practice Location

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