Provider Demographics
NPI:1639703499
Name:PARHAM, ARCHER BRANDON IV (PSYD)
Entity type:Individual
Prefix:MR
First Name:ARCHER
Middle Name:BRANDON
Last Name:PARHAM
Suffix:IV
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 S SEPULVEDA BLVD # 188
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4236
Mailing Address - Country:US
Mailing Address - Phone:424-250-0660
Mailing Address - Fax:
Practice Address - Street 1:11500 W OLYMPIC BLVD STE 420
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1564
Practice Address - Country:US
Practice Address - Phone:424-250-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2024-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY35009103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical