Provider Demographics
NPI:1609558519
Name:BEYOND PSYCHOLOGY CENTER: INDIVIDUAL AND FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:BEYOND PSYCHOLOGY CENTER: INDIVIDUAL AND FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:323-471-4994
Mailing Address - Street 1:12401 WILSHIRE BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1087
Mailing Address - Country:US
Mailing Address - Phone:323-471-4994
Mailing Address - Fax:
Practice Address - Street 1:12401 WILSHIRE BLVD STE 303
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1087
Practice Address - Country:US
Practice Address - Phone:323-471-4994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)