Provider Demographics
NPI:1255469680
Name:STRAYHORN, RENALDO
Entity Type:Individual
Prefix:
First Name:RENALDO
Middle Name:
Last Name:STRAYHORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38074
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-0074
Mailing Address - Country:US
Mailing Address - Phone:818-753-6606
Mailing Address - Fax:
Practice Address - Street 1:8235 SANTA MONICA BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5914
Practice Address - Country:US
Practice Address - Phone:818-753-6606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist