Provider Demographics
NPI:1265649792
Name:PRACTICAL PSYCHOLOGY
Entity Type:Organization
Organization Name:PRACTICAL PSYCHOLOGY
Other - Org Name:EVAN LANDRUM, PSY.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LANDRUM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:626-808-7152
Mailing Address - Street 1:2629 CALLE MARTOS
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-2251
Mailing Address - Country:US
Mailing Address - Phone:626-808-7152
Mailing Address - Fax:888-898-4591
Practice Address - Street 1:1755 HUNTINGTON DR
Practice Address - Street 2:#104
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2567
Practice Address - Country:US
Practice Address - Phone:626-808-7152
Practice Address - Fax:888-898-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19391103G00000X, 103T00000X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID NUMBER