Provider Demographics
NPI:1629427646
Name:MALAKUTI PSYCHOLOGICAL HEALTH GROUP INC
Entity Type:Organization
Organization Name:MALAKUTI PSYCHOLOGICAL HEALTH GROUP INC
Other - Org Name:KATRIN MALAKUTI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAKUTI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:424-645-7793
Mailing Address - Street 1:9171 WILSHIRE BLVD STE 660
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5540
Mailing Address - Country:US
Mailing Address - Phone:424-645-7793
Mailing Address - Fax:310-273-1010
Practice Address - Street 1:9171 WILSHIRE BLVD STE 660
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5540
Practice Address - Country:US
Practice Address - Phone:424-645-7793
Practice Address - Fax:310-273-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26550103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB226632Medicaid