Organization
DR. WIYATTA PSYCHOLOGY CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WIYATTA FAHNBULLEH PSYD (PSYCHOLOGIST)
(310) 621-3673
Entity
Organization
Contact information
Practice address
10153 1/2 RIVERSIDE DR STE 440, TOLUCA LAKE, CA 91602-2561
(310) 621-3673
Mailing address
10153 1/2 RIVERSIDE DR STE 440, TOLUCA LAKE, CA 91602-2561
(310) 621-3673
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
10/08/2020
Last updated
10/08/2020
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