Basic Information
| Provider Information | |||||||||
| NPI: | 1689868754 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OH | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | |||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 560 S ST LOUIS ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900334390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232614900 | ||||||||
| FaxNumber: | 3232614343 | ||||||||
| Practice Location | |||||||||
| Address1: | 560 S ST LOUIS ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900334390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232614900 | ||||||||
| FaxNumber: | 3232614343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2007 | ||||||||
| LastUpdateDate: | 10/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103T00000X | CA | N | Behavioral Health & Social Service Providers | Psychologist | 225C00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | 103TC0700X | PSY26714 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.