| Lifespan: A Center For Family Psychological Services Inc. | |
|
2801 Townsgate Rd Ste 133 Thousand Oaks CA 91361-5834 | |
| (805) 852-5039 | |
| (818) 279-0585 |
| Full Name | Lifespan: A Center For Family Psychological Services Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 2801 Townsgate Rd Ste 133, Thousand Oaks, California |
| Authorized Official Name and Position | Edmon Artinyan (CFO) |
| Authorized Official Contact | 8058525039 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifespan: A Center For Family Psychological Services Inc. 964 El Segundo Dr Thousand Oaks CA 91362-2201 Ph: () - | Lifespan: A Center For Family Psychological Services Inc. 2801 Townsgate Rd Ste 133 Thousand Oaks CA 91361-5834 Ph: (805) 852-5039 |
| NPI Number | 1255096426 |
|---|---|
| Provider Enumeration Date | 11/03/2021 |
| Last Update Date | 12/07/2022 |
| Certification Date | 11/10/2021 |
| Medicare PECOS PAC ID | 1850773482 |
|---|---|
| Medicare Enrollment ID | O20220729000234 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255096426 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Beatrix S Wagner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639358385 PECOS PAC ID: 1850618208 Enrollment ID: I20190531002127 |
| Provider Name | Edmon Psy D Artinyan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578030953 PECOS PAC ID: 5597191502 Enrollment ID: I20200211003020 |
| Provider Name | Dzovak Kazandjian |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609329291 PECOS PAC ID: 0345671483 Enrollment ID: I20200505003359 |
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