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Organization
NEUROEDGE PSYCHOLOGICAL SERVICES, INC.
Active
Organization
NEUROEDGE PSYCHOLOGICAL SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BEATRIX SIBYLLE WAGNER PSY.D. (CLINICAL PSYCHOLOGIST/CEO)
(310) 995-7427
Entity
Organization
Contact information
Practice address
964 EL SEGUNDO DR, THOUSAND OAKS, CA 91362-2201
(310) 995-7427
Mailing address
964 EL SEGUNDO DR, THOUSAND OAKS, CA 91362-2201
(310) 995-7427
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12409169
ANTHEM BLUE CROSS
CA
01
—
1639358385
ANTHEM BLUE CROSS
CA
05
—
1639358385
—
CA
01
—
PG0112723001
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
01/07/2025
Last updated
01/07/2025
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