Provider Demographics
NPI:1912644196
Name:POUR, SCHYNA
Entity Type:Individual
Prefix:
First Name:SCHYNA
Middle Name:
Last Name:POUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 WILSHIRE BLVD STE 1618
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4007
Mailing Address - Country:US
Mailing Address - Phone:424-284-2440
Mailing Address - Fax:
Practice Address - Street 1:1127 WILSHIRE BLVD STE 1618
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4007
Practice Address - Country:US
Practice Address - Phone:424-284-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1079671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical