Provider Demographics
NPI:1689684607
Name:CULVER CITY PSYCHOLOGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CULVER CITY PSYCHOLOGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WITHERSPOON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RN, CNS
Authorized Official - Phone:310-838-2738
Mailing Address - Street 1:PO BOX 2900
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90231-2900
Mailing Address - Country:US
Mailing Address - Phone:310-838-2738
Mailing Address - Fax:310-838-2729
Practice Address - Street 1:5000 OVERLAND AVE
Practice Address - Street 2:8
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4995
Practice Address - Country:US
Practice Address - Phone:310-838-2738
Practice Address - Fax:310-838-2729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13838103TC0700X
CAPSY15514103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19626Medicare ID - Type Unspecified