Provider Demographics
NPI:1518130905
Name:THE CENTER FOR NEUROTHERAPY
Entity Type:Organization
Organization Name:THE CENTER FOR NEUROTHERAPY
Other - Org Name:PERRI W. JOHNSON, PH.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRI
Authorized Official - Middle Name:W
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-512-7150
Mailing Address - Street 1:3330 BARHAM BOULEVARD
Mailing Address - Street 2:SUITE 101-102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068
Mailing Address - Country:US
Mailing Address - Phone:323-512-7150
Mailing Address - Fax:323-512-2041
Practice Address - Street 1:3330 BARHAM BLVD
Practice Address - Street 2:SUITE 101-102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1400
Practice Address - Country:US
Practice Address - Phone:323-512-7150
Practice Address - Fax:323-512-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY144313251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP14431AMedicare UPIN