Provider Demographics
NPI:1720433527
Name:THE BLUE CLINIC: A PSYCHOLOGY PRACTICE
Entity Type:Organization
Organization Name:THE BLUE CLINIC: A PSYCHOLOGY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAOBI
Authorized Official - Middle Name:I
Authorized Official - Last Name:ANYEJI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:213-290-4183
Mailing Address - Street 1:633 W 5TH ST
Mailing Address - Street 2:2600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90071-2005
Mailing Address - Country:US
Mailing Address - Phone:213-290-4183
Mailing Address - Fax:
Practice Address - Street 1:633 W 5TH ST
Practice Address - Street 2:2600
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90071-2005
Practice Address - Country:US
Practice Address - Phone:213-290-4183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26828103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty