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Organization
SLO PSYCHOLOGICAL SERVICES
Active
Organization
SLO PSYCHOLOGICAL SERVICES
Active
Other names
SLO Psych Services
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MIRIAM BURLAKOVSKY LEP#4368, BCBA (CEO)
(805) 316-1410
Entity
Organization
Contact information
Practice address
901 OAK PARK BLVD STE 202, PISMO BEACH, CA 93449-3410
(805) 316-1410
Mailing address
PO BOX 565, PISMO BEACH, CA 93448-0565
(805) 316-1410
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
—
—
103T00000X
Psychologist
Primary
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
Other
Enumeration date
04/04/2025
Last updated
04/04/2025
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