Provider Demographics
NPI:1396220752
Name:WESTSIDE PSYCH, A GROUP PSYCHOLOGY PRACTICE
Entity Type:Organization
Organization Name:WESTSIDE PSYCH, A GROUP PSYCHOLOGY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:STREETEN
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:213-373-4784
Mailing Address - Street 1:12304 SANTA MONICA BLVD STE 379
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1542
Mailing Address - Country:US
Mailing Address - Phone:213-373-4784
Mailing Address - Fax:
Practice Address - Street 1:12304 SANTA MONICA BLVD STE 379
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1542
Practice Address - Country:US
Practice Address - Phone:213-373-4784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty