Provider Demographics
NPI:1942507694
Name:ENGAGE PSYCHOLOGICAL SERVICES INC
Entity Type:Organization
Organization Name:ENGAGE PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:8054-970-0605
Mailing Address - Street 1:650 HAMPSHIRE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2510
Mailing Address - Country:US
Mailing Address - Phone:805-497-0605
Mailing Address - Fax:805-371-4862
Practice Address - Street 1:650 HAMPSHIRE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2510
Practice Address - Country:US
Practice Address - Phone:805-497-0605
Practice Address - Fax:805-371-4862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41847101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty