Provider Demographics
NPI:1477281434
Name:LOS ANGELES THERAPY COLLECTIVE, LICENSED CLINICAL SOCIAL WORKERS, INC.
Entity Type:Organization
Organization Name:LOS ANGELES THERAPY COLLECTIVE, LICENSED CLINICAL SOCIAL WORKERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAYTLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIROUNIAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:323-305-9933
Mailing Address - Street 1:1920 HILLHURST AVE # 1066
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2712
Mailing Address - Country:US
Mailing Address - Phone:323-305-9933
Mailing Address - Fax:
Practice Address - Street 1:2453 LOMA VISTA ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-3404
Practice Address - Country:US
Practice Address - Phone:323-305-9933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty