Provider Demographics
NPI:1922600832
Name:COPE PSYCHOLOGICAL CENTER
Entity Type:Organization
Organization Name:COPE PSYCHOLOGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHODDAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-938-4193
Mailing Address - Street 1:9461 CHARLEVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3017
Mailing Address - Country:US
Mailing Address - Phone:424-276-0430
Mailing Address - Fax:
Practice Address - Street 1:1626 WESTWOOD BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5621
Practice Address - Country:US
Practice Address - Phone:424-276-0430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-15
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health