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Organization
MY LA THERAPY
Active
Organization
MY LA THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROOKE SPROWL (OWNER/FOUNDER)
(949) 295-0980
Entity
Organization
Contact information
Practice address
130 OCEAN PARK BLVD UNIT 232, SANTA MONICA, CA 90405-3566
(949) 295-0980
Mailing address
130 OCEAN PARK BLVD UNIT 232, SANTA MONICA, CA 90405-3566
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568631141
NPI
CA
Enumeration date
03/26/2024
Last updated
04/02/2024
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