Provider Demographics
NPI:1427504281
Name:THERAPEUTIC INTEGRATIVE PSYCHOTHERAPY CLINIC, INC.
Entity type:Organization
Organization Name:THERAPEUTIC INTEGRATIVE PSYCHOTHERAPY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-445-8900
Mailing Address - Street 1:14320 VENTURA BLVD # 1129
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2717
Mailing Address - Country:US
Mailing Address - Phone:323-445-8900
Mailing Address - Fax:323-345-5778
Practice Address - Street 1:2171 14TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1840
Practice Address - Country:US
Practice Address - Phone:323-445-8900
Practice Address - Fax:323-345-5778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1184002156OtherNPI TYPE 1