Provider Demographics
NPI:1952023103
Name:ELYSIAN PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:ELYSIAN PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:SKARLATO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:213-595-3450
Mailing Address - Street 1:1211 SUNSET PLAZA DR APT 213
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-1249
Mailing Address - Country:US
Mailing Address - Phone:213-595-3450
Mailing Address - Fax:
Practice Address - Street 1:3477 WRIGHTWOOD DR
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3942
Practice Address - Country:US
Practice Address - Phone:213-595-3450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty