| Family Psychological Clinic Inc | |
|
12301 Califa St Valley Village CA 91607-1106 | |
| (310) 500-5193 | |
| Not Available |
| Full Name | Family Psychological Clinic Inc |
|---|---|
| Speciality | Psychologist |
| Location | 12301 Califa St, Valley Village, California |
| Authorized Official Name and Position | Shully Salman (OWNER) |
| Authorized Official Contact | 3105005193 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Psychological Clinic Inc 12301 Califa St Valley Village CA 91607-1106 Ph: (310) 500-5193 | Family Psychological Clinic Inc 12301 Califa St Valley Village CA 91607-1106 Ph: (310) 500-5193 |
| NPI Number | 1265289300 |
|---|---|
| Provider Enumeration Date | 05/06/2024 |
| Last Update Date | 05/06/2024 |
| Certification Date | 05/06/2024 |
| Medicare PECOS PAC ID | 0345682159 |
|---|---|
| Medicare Enrollment ID | O20240524001775 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265289300 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Shully Salman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558695049 PECOS PAC ID: 6406162650 Enrollment ID: I20160321001264 |
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