Provider Demographics
NPI:1518154103
Name:DR. KATHERINE L. SELLWOOD, INC.
Entity Type:Organization
Organization Name:DR. KATHERINE L. SELLWOOD, INC.
Other - Org Name:SELLWOOD & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SELLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:818-907-5491
Mailing Address - Street 1:16311 VENTURA BLVD
Mailing Address - Street 2:SUITE 977
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2124
Mailing Address - Country:US
Mailing Address - Phone:818-907-5491
Mailing Address - Fax:
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:SUITE 977
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2124
Practice Address - Country:US
Practice Address - Phone:818-907-5491
Practice Address - Fax:818-907-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18136251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
W17846Medicare PIN