Provider Demographics
NPI:1912670613
Name:CALIFORNIA WOMEN S THERAPY PSYCHOLOGICAL SERVICES CORPORATION
Entity Type:Organization
Organization Name:CALIFORNIA WOMEN S THERAPY PSYCHOLOGICAL SERVICES CORPORATION
Other - Org Name:CALIFORNIA WOMEN'S THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDYN
Authorized Official - Middle Name:SATER
Authorized Official - Last Name:TROCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-526-5268
Mailing Address - Street 1:17706 HILLSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-5874
Mailing Address - Country:US
Mailing Address - Phone:812-454-7472
Mailing Address - Fax:
Practice Address - Street 1:17706 HILLSIDE WAY
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-5874
Practice Address - Country:US
Practice Address - Phone:812-454-7472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty