Provider Demographics
NPI:1679008817
Name:UCLA SEMEL INSTITUTE
Entity Type:Organization
Organization Name:UCLA SEMEL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGY TRAINING PROGRAM
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-794-5715
Mailing Address - Street 1:615 6TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3807
Mailing Address - Country:US
Mailing Address - Phone:360-581-4703
Mailing Address - Fax:
Practice Address - Street 1:615 6TH ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3807
Practice Address - Country:US
Practice Address - Phone:360-581-4703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit