Provider Demographics
NPI:1649143322
Name:RASPUDIC PROFESSIONAL CLINICAL COUNSELOR, P.C.
Entity type:Organization
Organization Name:RASPUDIC PROFESSIONAL CLINICAL COUNSELOR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:RASPUDIC
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:805-813-3459
Mailing Address - Street 1:578 WASHINGTON BLVD # 508
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5421
Mailing Address - Country:US
Mailing Address - Phone:805-222-6289
Mailing Address - Fax:
Practice Address - Street 1:13323 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5170
Practice Address - Country:US
Practice Address - Phone:805-222-6289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-27
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty