Provider Demographics
NPI:1841208790
Name:A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:562-493-4655
Mailing Address - Street 1:5188 KATELLA AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720
Mailing Address - Country:US
Mailing Address - Phone:562-493-4655
Mailing Address - Fax:562-493-8897
Practice Address - Street 1:5188 KATELLA AVE
Practice Address - Street 2:STE 205
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720
Practice Address - Country:US
Practice Address - Phone:562-493-4655
Practice Address - Fax:562-493-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6896103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00PL68960OtherBLUE CROSS BLUE SHIELD
00PL68960OtherBLUE CROSS BLUE SHIELD