Provider Demographics
NPI:1992997597
Name:PACIFIC FORENSIC PSYCHOLOGY ASSOCIATES, INC
Entity type:Organization
Organization Name:PACIFIC FORENSIC PSYCHOLOGY ASSOCIATES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:213-738-8853
Mailing Address - Street 1:616 SHATTO PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1301
Mailing Address - Country:US
Mailing Address - Phone:213-738-8853
Mailing Address - Fax:213-738-5368
Practice Address - Street 1:616 SHATTO PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1301
Practice Address - Country:US
Practice Address - Phone:213-738-8853
Practice Address - Fax:213-738-5368
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFIC FORENSIC PSYCHOLOGY ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0400X, 103TB0200X
CA103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty