Provider Demographics
NPI:1235716978
Name:COUNSELING CENTER OF SANTA MONICA - A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:COUNSELING CENTER OF SANTA MONICA - A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAISMAN-TZACHOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-477-6000
Mailing Address - Street 1:1731 BARRY AVE APT 112
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4090
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3611 LAKE CREST DR
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-7982
Practice Address - Country:US
Practice Address - Phone:951-457-2493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility