Organization
ELYSIAN PSYCHOLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDRA ISAACS PSYD (OWNER)
(773) 412-7274
Entity
Organization
Contact information
Practice address
10250 CONSTELLATION BLVD, LOS ANGELES, CA 90067-6200
(312) 388-8008
Mailing address
5315 N CLARK ST STE 166, CHICAGO, IL 60640-2290
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1689987281
NATIONAL PLAN & PROVIDER ENUMERATION SYSTEM
CA
Enumeration date
04/15/2020
Last updated
04/15/2020
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