Provider Demographics
NPI:1104422997
Name:AFFINITY HEALTH PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:AFFINITY HEALTH PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:METELLUS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:805-267-9531
Mailing Address - Street 1:PO BOX 57064
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91413-2064
Mailing Address - Country:US
Mailing Address - Phone:805-267-9531
Mailing Address - Fax:
Practice Address - Street 1:21900 BURBANK BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-7418
Practice Address - Country:US
Practice Address - Phone:805-267-9531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health