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877 N Douglas St El Segundo CA 90245-2801 | |
| (310) 536-0211 | |
| (310) 536-0215 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 877 N Douglas St, El Segundo, California |
| Authorized Official Name and Position | Megan Sullaway (PARTNER/OWNER) |
| Authorized Official Contact | 3105360211 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
877 N Douglas St El Segundo CA 90245-2801 Ph: (310) 536-0211 | 877 N Douglas St El Segundo CA 90245-2801 Ph: (310) 536-0211 |
| NPI Number | 1447422357 |
|---|---|
| Provider Enumeration Date | 03/31/2008 |
| Last Update Date | 07/28/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447422357 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PSY9947 (California) | Primary |
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