Provider Demographics
NPI:1154646271
Name:WALTER BROWN, PH.D., A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:WALTER BROWN, PH.D., A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-410-9504
Mailing Address - Street 1:5800 HANNUM AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6553
Mailing Address - Country:US
Mailing Address - Phone:310-410-9504
Mailing Address - Fax:310-410-9507
Practice Address - Street 1:5800 HANNUM AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6553
Practice Address - Country:US
Practice Address - Phone:310-410-9504
Practice Address - Fax:310-410-9507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19358103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty