| Therapeutic Integrative Psychotherapy Clinic, Inc. | |
|
4557 Haskell Ave Unit 301 Encino CA 91436-3152 | |
| (323) 445-8900 | |
| Not Available |
| Full Name | Therapeutic Integrative Psychotherapy Clinic, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 4557 Haskell Ave, Encino, California |
| Authorized Official Name and Position | Alan B Goodwin (PRESIDENT) |
| Authorized Official Contact | 3234458900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Therapeutic Integrative Psychotherapy Clinic, Inc. 16055 Ventura Blvd Suite 507 Encino CA 91436-2601 Ph: (323) 445-8900 | Therapeutic Integrative Psychotherapy Clinic, Inc. 4557 Haskell Ave Unit 301 Encino CA 91436-3152 Ph: (323) 445-8900 |
| NPI Number | 1427504281 |
|---|---|
| Provider Enumeration Date | 08/31/2016 |
| Last Update Date | 08/31/2016 |
| Medicare PECOS PAC ID | 2365720976 |
|---|---|
| Medicare Enrollment ID | O20161102002580 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427504281 | NPI | - | NPPES |
| 1184002156 | Other | CA | NPI TYPE 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | PSY19421 (California) | Primary |
| Provider Name | Alan B Goodwin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184002156 PECOS PAC ID: 5193012888 Enrollment ID: I20161102002842 |
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