# WEST LA THERAPIST CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417491952
- **Authorized official:** MRS. JACQUELINE BLOOM-GENEVITZ (CEO/PRESIDENT)
- **Authorized official phone:** (310) 582-1513

## Contact information

- **Practice address:** 11040 SANTA MONICA BLVD STE 209, LOS ANGELES, CA 90025-7522
- **Practice address phone:** (310) 582-1513
- **Mailing address:** 11040 SANTA MONICA BLVD STE 209, LOS ANGELES, CA 90025-7522

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | 43614 | CA | Yes |

## Other

- **Enumeration date:** 12/16/2016
- **Last updated:** 12/16/2016