Basic Information
| Provider Information | |||||||||
| NPI: | 1336659002 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ABS PSYCHOLOGY SERVICES CALIFORNIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16255 VENTURA BLVD STE 900 | ||||||||
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| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914362317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019354171 | ||||||||
| FaxNumber: | 8019354946 | ||||||||
| Practice Location | |||||||||
| Address1: | 9600 CENTER AVE STE 160 | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917305838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582645858 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2017 | ||||||||
| LastUpdateDate: | 11/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | YOUNG | ||||||||
| AuthorizedOfficialFirstName: | NICOLE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8582645858 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PSYD | ||||||||
| NPICertificationDate: | 11/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.