Provider Demographics
NPI:1750863452
Name:CENTER FOR COGNITIVE THERAPY AND SPORT PSYCHOLOGY, INC.
Entity Type:Organization
Organization Name:CENTER FOR COGNITIVE THERAPY AND SPORT PSYCHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:OAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-738-6302
Mailing Address - Street 1:3 POINTE DR STE 305
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-7623
Mailing Address - Country:US
Mailing Address - Phone:310-738-6302
Mailing Address - Fax:
Practice Address - Street 1:3 POINTE DR STE 305
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-7623
Practice Address - Country:US
Practice Address - Phone:310-738-6302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty