Provider Demographics
NPI:1356145684
Name:WESTSIDE WAVE CBT A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:WESTSIDE WAVE CBT A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CFO, SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUDSON GROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-701-5103
Mailing Address - Street 1:10323 SANTA MONICA BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5056
Mailing Address - Country:US
Mailing Address - Phone:310-701-5103
Mailing Address - Fax:
Practice Address - Street 1:10323 SANTA MONICA BLVD STE 111
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5056
Practice Address - Country:US
Practice Address - Phone:310-701-5103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty