Provider Demographics
NPI:1831464742
Name:PSYCHSERVES
Entity Type:Organization
Organization Name:PSYCHSERVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAELYN
Authorized Official - Middle Name:T
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-331-4559
Mailing Address - Street 1:626 WILSHIRE BLVD
Mailing Address - Street 2:910
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3209
Mailing Address - Country:US
Mailing Address - Phone:949-331-4559
Mailing Address - Fax:312-622-5633
Practice Address - Street 1:626 WILSHIRE BLVD
Practice Address - Street 2:910
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3209
Practice Address - Country:US
Practice Address - Phone:949-331-4559
Practice Address - Fax:312-622-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23509103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty