Provider Demographics
NPI:1932651817
Name:SILVER LAKE PSYCHOLOGY INC.
Entity Type:Organization
Organization Name:SILVER LAKE PSYCHOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-388-7983
Mailing Address - Street 1:4325 W SUNSET BLVD
Mailing Address - Street 2:206
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2174
Mailing Address - Country:US
Mailing Address - Phone:310-388-7983
Mailing Address - Fax:
Practice Address - Street 1:4325 W SUNSET BLVD
Practice Address - Street 2:206
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2174
Practice Address - Country:US
Practice Address - Phone:310-388-7983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22512103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty