Provider Demographics
NPI:1457809758
Name:CALIFORNIA THERAPY CENTER & PSYCHOLOGICAL SERVICES INC
Entity Type:Organization
Organization Name:CALIFORNIA THERAPY CENTER & PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:H
Authorized Official - Last Name:TAMASSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-396-5345
Mailing Address - Street 1:1101 N PACIFIC AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3250
Mailing Address - Country:US
Mailing Address - Phone:818-396-5343
Mailing Address - Fax:818-561-3997
Practice Address - Street 1:1101 N PACIFIC AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3250
Practice Address - Country:US
Practice Address - Phone:818-396-5343
Practice Address - Fax:818-561-3997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19694103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00CP196940Medicaid
CACP19694Medicare PIN