Provider Demographics
NPI:1306301593
Name:PEAK PSYCHOLOGY INC
Entity type:Organization
Organization Name:PEAK PSYCHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAURICELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-781-0187
Mailing Address - Street 1:3235 DONALD DOUGLAS LOOP S
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3213
Mailing Address - Country:US
Mailing Address - Phone:310-271-9660
Mailing Address - Fax:
Practice Address - Street 1:2211 CORINTH AVE STE 310
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1622
Practice Address - Country:US
Practice Address - Phone:310-781-0187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty