Provider Demographics
NPI:1780124990
Name:DYNAMIC LISTENING & LEARNING CENTERS INC
Entity type:Organization
Organization Name:DYNAMIC LISTENING & LEARNING CENTERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:VARADY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-392-1600
Mailing Address - Street 1:3101 OCEAN PARK BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3022
Mailing Address - Country:US
Mailing Address - Phone:310-392-1600
Mailing Address - Fax:310-392-7016
Practice Address - Street 1:3101 OCEAN PARK BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3022
Practice Address - Country:US
Practice Address - Phone:310-392-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25772103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty