Provider Demographics
NPI:1003912098
Name:ADVANTAGE PSYCHOLOGICAL SERVICES INC.
Entity Type:Organization
Organization Name:ADVANTAGE PSYCHOLOGICAL SERVICES INC.
Other - Org Name:FAMILY RESOURCE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEXI
Authorized Official - Middle Name:
Authorized Official - Last Name:WELANETZ-BURSIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-479-9798
Mailing Address - Street 1:11500 W OLYMPIC BLVD STE 420
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1564
Mailing Address - Country:US
Mailing Address - Phone:310-479-9798
Mailing Address - Fax:310-479-9796
Practice Address - Street 1:11500 W OLYMPIC BLVD STE 420
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1564
Practice Address - Country:US
Practice Address - Phone:310-479-9798
Practice Address - Fax:310-479-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16306103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17236Medicare ID - Type Unspecified
CAP25350Medicare UPIN