Provider Demographics
NPI:1417098716
Name:ALLIANCE PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:ALLIANCE PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIMON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-749-0317
Mailing Address - Street 1:21143 HAWTHORNE BLVD # 460
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4615
Mailing Address - Country:US
Mailing Address - Phone:310-749-0317
Mailing Address - Fax:310-373-2057
Practice Address - Street 1:15823 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3703
Practice Address - Country:US
Practice Address - Phone:310-749-0317
Practice Address - Fax:310-373-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17613103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16714Medicare ID - Type UnspecifiedGROUP MEDICARE ID NUMBER
CAP49304Medicare UPIN