1801122247 NPI number — ATOMIC SHRINK PSYCHOLOGY, INC.

Table of content: (NPI 1801122247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801122247 NPI number — ATOMIC SHRINK PSYCHOLOGY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATOMIC SHRINK PSYCHOLOGY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1801122247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17328 VENTURA BLVD
Provider Second Line Business Mailing Address:
SUITE 134
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91316-3904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-481-6581
Provider Business Mailing Address Fax Number:
800-976-0803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1034 W AVENUE L12
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-7083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-481-6581
Provider Business Practice Location Address Fax Number:
800-976-0803
Provider Enumeration Date:
10/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MASUDA-STORY
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
KEIKO
Authorized Official Title or Position:
CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
818-481-6581

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY20385 , 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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