Provider Demographics
NPI:1235742974
Name:FLOURISH PSYCHOLOGY CORPORATION
Entity Type:Organization
Organization Name:FLOURISH PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:RUGLESS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-954-2002
Mailing Address - Street 1:8500 WILSHIRE BLVD STE 700C
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3105
Mailing Address - Country:US
Mailing Address - Phone:310-954-2002
Mailing Address - Fax:
Practice Address - Street 1:8500 WILSHIRE BLVD STE 700C
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3105
Practice Address - Country:US
Practice Address - Phone:310-954-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1477920478OtherNPI