Provider Demographics
NPI:1598108912
Name:ARCHEUS PSYCHOLOGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ARCHEUS PSYCHOLOGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:424-271-2933
Mailing Address - Street 1:28625 S WESTERN AVE # 2024
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-0810
Mailing Address - Country:US
Mailing Address - Phone:424-271-2933
Mailing Address - Fax:
Practice Address - Street 1:22330 HAWTHORNE BLVD
Practice Address - Street 2:STE 207
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2552
Practice Address - Country:US
Practice Address - Phone:424-271-2933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24268103TB0200X, 103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty