| Mark John Souris | |
|
18757 Burbank Blvd Suite 125 Tarzana CA 91356-3375 | |
| (818) 635-9705 | |
| (818) 881-5504 |
| Full Name | Mark John Souris |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 18757 Burbank Blvd, Tarzana, California |
| Authorized Official Name and Position | Mark John Souris (OWNER) |
| Authorized Official Contact | 8186359705 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark John Souris 19701 Tuba St Chatsworth CA 91311-3547 Ph: (818) 635-9705 | Mark John Souris 18757 Burbank Blvd Suite 125 Tarzana CA 91356-3375 Ph: (818) 635-9705 |
| NPI Number | 1215381918 |
|---|---|
| Provider Enumeration Date | 04/19/2016 |
| Last Update Date | 04/19/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215381918 | NPI | - | NPPES |
| 14283 | Other | CA | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 14283 (California) | Primary |
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