| Elysian Psychology Inc | |
|
10250 Constellation Blvd Los Angeles CA 90067-6200 | |
| (312) 388-8008 | |
| Not Available |
| Full Name | Elysian Psychology Inc |
|---|---|
| Speciality | Psychologist |
| Location | 10250 Constellation Blvd, Los Angeles, California |
| Authorized Official Name and Position | Alexandra Isaacs (OWNER) |
| Authorized Official Contact | 7734127274 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elysian Psychology Inc 5315 N Clark St Ste 166 Chicago IL 60640-2290 Ph: () - | Elysian Psychology Inc 10250 Constellation Blvd Los Angeles CA 90067-6200 Ph: (312) 388-8008 |
| NPI Number | 1366061624 |
|---|---|
| Provider Enumeration Date | 04/15/2020 |
| Last Update Date | 04/15/2020 |
| Certification Date | 04/15/2020 |
| Medicare PECOS PAC ID | 0749604023 |
|---|---|
| Medicare Enrollment ID | O20200720002045 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366061624 | NPI | - | NPPES |
| 1689987281 | Other | CA | NATIONAL PLAN & PROVIDER ENUMERATION SYSTEM |
| Provider Name | Kim Boykin-johnson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689987281 PECOS PAC ID: 8729226006 Enrollment ID: I20130528000266 |
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