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Organization
WEST LA THERAPIST CORP
Active
Organization
WEST LA THERAPIST CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACQUELINE BLOOM-GENEVITZ (CEO/PRESIDENT)
(310) 582-1513
Entity
Organization
Contact information
Practice address
11040 SANTA MONICA BLVD STE 209, LOS ANGELES, CA 90025-7522
(310) 582-1513
Mailing address
11040 SANTA MONICA BLVD STE 209, LOS ANGELES, CA 90025-7522
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
43614
CA
Other
Enumeration date
12/16/2016
Last updated
12/16/2016
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