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Organization
MARK JOHN SOURIS
Active
Organization
MARK JOHN SOURIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK JOHN SOURIS PSYD (OWNER)
(818) 635-9705
Entity
Organization
Contact information
Practice address
18757 BURBANK BLVD, SUITE 125, TARZANA, CA 91356-3375
(818) 635-9705
(818) 881-5504
Mailing address
19701 TUBA ST, CHATSWORTH, CA 91311-3547
(818) 635-9705
(818) 881-5504
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
14283
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14283
LICENSE
CA
Enumeration date
04/19/2016
Last updated
04/19/2016
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