Provider Demographics
NPI:1760922991
Name:OCEANSIDE PSYCHOLOGY CLINIC
Entity Type:Organization
Organization Name:OCEANSIDE PSYCHOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:URVI
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-944-1058
Mailing Address - Street 1:P.O. BOX 3453
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277
Mailing Address - Country:US
Mailing Address - Phone:310-956-1406
Mailing Address - Fax:
Practice Address - Street 1:212 YACHT CLUB WAY STE A6
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-6907
Practice Address - Country:US
Practice Address - Phone:310-956-1406
Practice Address - Fax:424-262-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27868103T00000X
103TA0400X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty