Provider Demographics
NPI:1528317955
Name:BEACH CITIES PSYCHOLOGICAL SERVICES, INC.
Entity type:Organization
Organization Name:BEACH CITIES PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SOMMERFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-746-5929
Mailing Address - Street 1:934 HERMOSA AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-4122
Mailing Address - Country:US
Mailing Address - Phone:310-746-5929
Mailing Address - Fax:310-388-1268
Practice Address - Street 1:2615 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 325
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2225
Practice Address - Country:US
Practice Address - Phone:310-746-5929
Practice Address - Fax:310-379-6838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70014106H00000X
CAPSY22294103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty