Provider Demographics
NPI:1760194138
Name:DR. TAMALA BLACK AND ASSOCIATES
Entity Type:Organization
Organization Name:DR. TAMALA BLACK AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMALA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMFT 115219
Authorized Official - Phone:424-209-8053
Mailing Address - Street 1:6695 GREEN VALLEY CIR UNIT 2822
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7024
Mailing Address - Country:US
Mailing Address - Phone:424-209-8053
Mailing Address - Fax:
Practice Address - Street 1:3645 S MUIRFIELD RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-5717
Practice Address - Country:US
Practice Address - Phone:424-209-8053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty