Provider Demographics
NPI:1558935460
Name:ENDEAVOUR PSYCHOLOGY GROUP
Entity Type:Organization
Organization Name:ENDEAVOUR PSYCHOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-341-2049
Mailing Address - Street 1:888 W KNOLL DR APT 309
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4736
Mailing Address - Country:US
Mailing Address - Phone:310-666-4126
Mailing Address - Fax:
Practice Address - Street 1:888 W KNOLL DR APT 309
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4736
Practice Address - Country:US
Practice Address - Phone:310-666-4126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)