1124449889 NPI number — PACIFIC WEST COUNSELING CENTER INC Katrina Wood Ph.D

Table of content: Katrina Wood Ph.D (NPI 1124449889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124449889 NPI number — PACIFIC WEST COUNSELING CENTER INC Katrina Wood Ph.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC WEST COUNSELING CENTER INC
Provider Last Name:
Wood
Provider First Name:
Katrina
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Ph.D
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WILSHIRE THERAPY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124449889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13636 VENTURA BLVD
Provider Second Line Business Mailing Address:
SUITE 472
Provider Business Mailing Address City Name:
SHERMAN OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91423-3700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
8189060406
Provider Business Mailing Address Fax Number:
818-981-0649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16250 Ventura Blvd
Provider Second Line Business Practice Location Address:
Suite 465
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
8189060406
Provider Business Practice Location Address Fax Number:
818-981-0649
Provider Enumeration Date:
12/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WOOD
Authorized Official First Name:
MICK
Authorized Official Middle Name:
ARTHUR
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
818-623-4224

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  31664 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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