Provider Demographics
NPI:1164893376
Name:THE BELLA VITA, SANTA CLARITA
Entity Type:Organization
Organization Name:THE BELLA VITA, SANTA CLARITA
Other - Org Name:A BEAUTIFUL LIFE PSYCHOLOGY GROUP, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BILLING AND COLLECTIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-255-0400
Mailing Address - Street 1:766 COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90060-0041
Mailing Address - Country:US
Mailing Address - Phone:323-255-0400
Mailing Address - Fax:323-255-0177
Practice Address - Street 1:23861 MCBEAN PKWY #E25
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355
Practice Address - Country:US
Practice Address - Phone:323-255-0400
Practice Address - Fax:323-255-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty