Provider Demographics
NPI:1356519821
Name:THE KIAMSHA GROUP
Entity type:Organization
Organization Name:THE KIAMSHA GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:213-617-9087
Mailing Address - Street 1:123 S FIGUEROA ST
Mailing Address - Street 2:SUITE NO. 1038
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2469
Mailing Address - Country:US
Mailing Address - Phone:213-617-8955
Mailing Address - Fax:213-620-1549
Practice Address - Street 1:3660 WILSHIRE BLVD
Practice Address - Street 2:SUITE 907
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2719
Practice Address - Country:US
Practice Address - Phone:213-617-8955
Practice Address - Fax:213-620-1549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty