Provider Demographics
NPI:1659851053
Name:LASEY'S PSYCHOTHERAPY SERVICES, INC
Entity Type:Organization
Organization Name:LASEY'S PSYCHOTHERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:LASEY
Authorized Official - Last Name:GARY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:562-205-8846
Mailing Address - Street 1:1232 E WARDLOW RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4833
Mailing Address - Country:US
Mailing Address - Phone:562-205-8846
Mailing Address - Fax:
Practice Address - Street 1:1232 E WARDLOW RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4833
Practice Address - Country:US
Practice Address - Phone:562-205-8846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS29611101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00000OtherMENTAL HEALTH