Provider Demographics
NPI:1649557232
Name:KOUDSI, JOSEPH JOHNNY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHNNY
Last Name:KOUDSI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JOHNNY
Other - Middle Name:
Other - Last Name:KOUDSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:12214 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3830
Mailing Address - Country:US
Mailing Address - Phone:310-284-3626
Mailing Address - Fax:
Practice Address - Street 1:12214 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91607-3830
Practice Address - Country:US
Practice Address - Phone:310-284-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24646103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical