Provider Demographics
NPI:1124718457
Name:PSYCHE THERAPY INC.
Entity type:Organization
Organization Name:PSYCHE THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLENI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:818-790-0418
Mailing Address - Street 1:1346 FOOTHILLL BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1346 FOOTHILLL BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011
Practice Address - Country:US
Practice Address - Phone:818-790-0418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty