| Shully Salman Psyd A Psychological Corp | |
|
12301 Califa St Valley Village CA 91607-1106 | |
| (310) 500-5193 | |
| Not Available |
| Full Name | Shully Salman Psyd A Psychological Corp |
|---|---|
| Speciality | Psychologist |
| Location | 12301 Califa St, Valley Village, California |
| Authorized Official Name and Position | Shully Salman (OWNER, PSYD) |
| Authorized Official Contact | 3105005193 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shully Salman Psyd A Psychological Corp 12301 Califa St Valley Village CA 91607-1106 Ph: (310) 500-5193 | Shully Salman Psyd A Psychological Corp 12301 Califa St Valley Village CA 91607-1106 Ph: (310) 500-5193 |
| NPI Number | 1619412194 |
|---|---|
| Provider Enumeration Date | 12/20/2016 |
| Last Update Date | 01/02/2019 |
| Medicare PECOS PAC ID | 1153604640 |
|---|---|
| Medicare Enrollment ID | O20170207002198 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619412194 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 27314 (California) | Primary |
| Provider Name | Shully Salman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558695049 PECOS PAC ID: 6406162650 Enrollment ID: I20160321001264 |
| Provider Name | Carol Jean Owen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487296422 PECOS PAC ID: 5597198689 Enrollment ID: I20191203002673 |
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