Provider Demographics
NPI:1811452196
Name:PSYCH LAB PSYCHOLOGY, INC.
Entity type:Organization
Organization Name:PSYCH LAB PSYCHOLOGY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GODOT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:562-684-1305
Mailing Address - Street 1:5150 E PACIFIC COAST HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3399
Mailing Address - Country:US
Mailing Address - Phone:323-942-9668
Mailing Address - Fax:323-400-4182
Practice Address - Street 1:3950 LONG BEACH BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-5410
Practice Address - Country:US
Practice Address - Phone:562-684-1300
Practice Address - Fax:562-684-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty