Provider Demographics
NPI:1588226393
Name:DEFINING MOMENTS PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:DEFINING MOMENTS PSYCHOLOGICAL CORPORATION
Other - Org Name:DEFINING MOMENTS COUNSELING & ASSESSMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:818-900-5152
Mailing Address - Street 1:11712 MOORPARK ST STE 105
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2156
Mailing Address - Country:US
Mailing Address - Phone:818-900-5152
Mailing Address - Fax:
Practice Address - Street 1:11712 MOORPARK ST STE 105
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2156
Practice Address - Country:US
Practice Address - Phone:818-900-5152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-01
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty