Provider Demographics
NPI:1427386374
Name:WILSHIRE VALLEY THERAPY CENTER
Entity Type:Organization
Organization Name:WILSHIRE VALLEY THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-651-5828
Mailing Address - Street 1:6399 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5703
Mailing Address - Country:US
Mailing Address - Phone:323-651-5828
Mailing Address - Fax:323-651-5836
Practice Address - Street 1:6399 WILSHIRE BLVD
Practice Address - Street 2:SUITE 312
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5703
Practice Address - Country:US
Practice Address - Phone:323-651-5828
Practice Address - Fax:323-651-5836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45064106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty