Provider Demographics
NPI:1649807058
Name:NICHOLAS S. THALER PHD A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:NICHOLAS S. THALER PHD A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZATION OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:THALER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-570-5113
Mailing Address - Street 1:2950 S BENTLEY AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4072
Mailing Address - Country:US
Mailing Address - Phone:310-570-5113
Mailing Address - Fax:
Practice Address - Street 1:1526 14TH ST STE 109
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3320
Practice Address - Country:US
Practice Address - Phone:310-570-5113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty