| Southland Psychology Inc | |
|
15300 Ventura Blvd Ste 301 Sherman Oaks CA 91403-3103 | |
| (310) 551-8535 | |
| Not Available |
| Full Name | Southland Psychology Inc |
|---|---|
| Speciality | Psychologist |
| Location | 15300 Ventura Blvd Ste 301, Sherman Oaks, California |
| Authorized Official Name and Position | Jane Beresford (PSY.D, OWNER) |
| Authorized Official Contact | 3105518535 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southland Psychology Inc 15300 Ventura Blvd Ste 301 Sherman Oaks CA 91403-3103 Ph: (310) 551-8535 | Southland Psychology Inc 15300 Ventura Blvd Ste 301 Sherman Oaks CA 91403-3103 Ph: (310) 551-8535 |
| NPI Number | 1043738412 |
|---|---|
| Provider Enumeration Date | 09/06/2017 |
| Last Update Date | 06/11/2019 |
| Medicare PECOS PAC ID | 9638617632 |
|---|---|
| Medicare Enrollment ID | O20240821000763 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043738412 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 16618 (California) | Primary |
| Provider Name | Bethany Walters |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669223640 PECOS PAC ID: 4183164197 Enrollment ID: I20240905000832 |
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