Provider Demographics
NPI:1265824346
Name:NICOLE PICKERING
Entity Type:Organization
Organization Name:NICOLE PICKERING
Other - Org Name:CBT TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PICKERING
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:424-262-2014
Mailing Address - Street 1:PO BOX 4001
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-7001
Mailing Address - Country:US
Mailing Address - Phone:424-262-2014
Mailing Address - Fax:
Practice Address - Street 1:3701 HIGHLAND AVE STE 303B
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-3281
Practice Address - Country:US
Practice Address - Phone:424-262-2014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26487103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty