Provider Demographics
NPI:1699980656
Name:ACKERMAN-KALLA, LANI (PHD)
Entity type:Individual
Prefix:DR
First Name:LANI
Middle Name:
Last Name:ACKERMAN-KALLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LANI
Other - Middle Name:M
Other - Last Name:ACKERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3201 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2344
Mailing Address - Country:US
Mailing Address - Phone:310-998-5583
Mailing Address - Fax:310-998-5582
Practice Address - Street 1:3201 WILSHIRE BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2344
Practice Address - Country:US
Practice Address - Phone:310-998-5583
Practice Address - Fax:310-998-5582
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12254103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical