1891032652 NPI number — EMMADA PSYCHOLOGY CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891032652 NPI number — EMMADA PSYCHOLOGY CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMMADA PSYCHOLOGY CENTER, 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:
1891032652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
595 E COLORADO BLVD STE 211
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91101-2028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-863-4645
Provider Business Mailing Address Fax Number:
866-863-4824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8939 S SEPULVEDA BLVD
Provider Second Line Business Practice Location Address:
SUITE #200
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90045-3631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-903-0840
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILLIAMSON
Authorized Official First Name:
RICKEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
866-863-4645

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  21442 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 23098 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 20072 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC2200X , with the licence number: 24532 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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