Provider Demographics
NPI:1811442767
Name:SOUTH BAY TMS THERAPY CENTER
Entity type:Organization
Organization Name:SOUTH BAY TMS THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-318-2566
Mailing Address - Street 1:515 LARSSON ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6734
Mailing Address - Country:US
Mailing Address - Phone:310-318-2566
Mailing Address - Fax:
Practice Address - Street 1:509 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6746
Practice Address - Country:US
Practice Address - Phone:310-318-2566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTHA B KOO, MD, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-21
Last Update Date:2016-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78080101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty