Organization
SPORTS CONCUSSION INSTITUTE A PSYCHOLOGY GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TONY L STRICKLAND P.H.D. (OWNER PROVIDER)
(310) 643-9595
Entity
Organization
Contact information
Practice address
5230 PACIFIC CONCOURSE DR, SUITE 300, LOS ANGELES, CA 90045-6200
(310) 643-9595
(310) 643-5180
Mailing address
5230 PACIFIC CONCOURSE DRIVE, SUITE 300, LOS ANGELES, CA 90045-6200
(310) 643-9595
(310) 643-5180
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY12223
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ50434Y
BLUE SHIELD
CA
Enumeration date
11/10/2006
Last updated
01/09/2017
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