Provider Demographics
NPI:1275670036
Name:EXECUTIVE MENTAL HEALTH, INC.
Entity Type:Organization
Organization Name:EXECUTIVE MENTAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARI
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KALECHSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-273-4843
Mailing Address - Street 1:11835 W OLYMPIC BLVD STE 1270E
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-5001
Mailing Address - Country:US
Mailing Address - Phone:310-273-4843
Mailing Address - Fax:310-273-5056
Practice Address - Street 1:11835 W OLYMPIC BLVD STE 1270E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-5001
Practice Address - Country:US
Practice Address - Phone:310-273-4843
Practice Address - Fax:310-273-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14872101YM0800X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA546788Medicaid