Provider Demographics
NPI:1043224959
Name:PRO PSYCH SERVICES INC
Entity Type:Organization
Organization Name:PRO PSYCH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:818-821-6012
Mailing Address - Street 1:12501 CHANDLER BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1955
Mailing Address - Country:US
Mailing Address - Phone:818-821-6012
Mailing Address - Fax:818-821-6014
Practice Address - Street 1:12501 CHANDLER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-1955
Practice Address - Country:US
Practice Address - Phone:818-821-6012
Practice Address - Fax:818-821-6014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y02402Medicare UPIN
W16924Medicare ID - Type Unspecified