Provider Demographics
NPI:1417332545
Name:GOLDEN STATE NEUROPLASTICS, INC.
Entity Type:Organization
Organization Name:GOLDEN STATE NEUROPLASTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:BARTLETT
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-863-6199
Mailing Address - Street 1:1323 W FRANCISQUITO AVE
Mailing Address - Street 2:#80
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-4656
Mailing Address - Country:US
Mailing Address - Phone:310-863-6199
Mailing Address - Fax:888-789-9773
Practice Address - Street 1:626 WILSHIRE BLVD
Practice Address - Street 2:SUITE 910
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3209
Practice Address - Country:US
Practice Address - Phone:310-863-6199
Practice Address - Fax:888-789-9773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24447261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)