Provider Demographics
NPI:1578991691
Name:DAVID L. RAFFLE, PHD, INC., A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:DAVID L. RAFFLE, PHD, INC., A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAFFLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:800-450-9799
Mailing Address - Street 1:2001 S BARRINGTON AVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5363
Mailing Address - Country:US
Mailing Address - Phone:800-450-9799
Mailing Address - Fax:310-470-4411
Practice Address - Street 1:2001 S BARRINGTON AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5363
Practice Address - Country:US
Practice Address - Phone:800-450-9799
Practice Address - Fax:310-470-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25732103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty