Provider Demographics
NPI:1497400659
Name:PSYCHE FITNESS
Entity Type:Organization
Organization Name:PSYCHE FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LANI
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-991-3055
Mailing Address - Street 1:3343 W 152ND ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-3901
Mailing Address - Country:US
Mailing Address - Phone:310-991-3055
Mailing Address - Fax:
Practice Address - Street 1:3820 DEL AMO BLVD STE 207
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-2148
Practice Address - Country:US
Practice Address - Phone:310-991-3055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty