DOCTOR TLC, LICENSE CLINICAL PSYCHOLOGIST, INC. (NPI# 1528507084) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528507084 |
| Entity Type | Organization |
| Organization Name | DOCTOR TLC, LICENSE CLINICAL PSYCHOLOGIST, INC. |
| Other Organization Name | TERESA L. CHUNG, PSY.D. |
| Practice Address |
1242 Third St Promenade Suite 208 Santa Monica CA 90401 |
| Practice Telephone | 2014069496 |
| Mailing Telephone | 2014069496 |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2019-07-17 |
| Authorized Official Name | DR. TERESA LIAW CHUNG (CEO) |
| Authorized Official Telephone | 4242725233 |
| Authorized Official Credential | PSY.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | PSY27669 | CA | Agencies |
| Other Name | Type Code |
|---|---|
| Teresa L. Chung, Psy.D. | Former Legal Business Name - Organization |
| Street Address |
1242 THIRD ST PROMENADE, SUITE 208 |
| City | SANTA MONICA |
| State | CA |
| Zip Code | 90401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013499458 | Franchesca Johnson Gordon | Marriage & Family Therapist | 900 Wilshire Blvd., Ste. 450, Santa Monica, CA 90401 | 2018-09-01 |
| 1629564083 | Michelle Jillian Dolinsky | Social Worker | 1243 7th St Ste C, Santa Monica, CA 90401 | 2018-07-09 |
| 1285006023 | Venessa Leeann Roca | Speech-Language Pathologist | 1218 6th Street, Santa Monica, CA 90401 | 2015-10-20 |
| 1720468036 | Stephen J. Kenneally | Marriage & Family Therapist | 610 Santa Monica Bvd, Ste. 201, Santa Monica, CA 90401 | 2015-06-02 |
| 1629458070 | Dominique L Robertson | Marriage & Family Therapist | 530 Wilshire, #310, Santa Monica, CA 90401 | 2015-06-01 |
| 1205252673 | Santa Monica Sports Medicine Inc. | Physical Medicine & Rehabilitation | 900 Wilshire Blvd. #410, Santa Monica, CA 90401 | 2014-03-10 |
| 1154675023 | Sherry Marie Martyn | Psychologist | 1242 3rd Street Promenade Ste 208, Santa Monica, CA 90401 | 2012-10-31 |
| 1700159829 | Gary Warburton | Dentist | 519 Arizona Ave., Santa Monica, CA 90401 | 2012-02-21 |
| 1265713036 | Aleksandr Mailyan | Reflexologist | 201 Wilshire Blvd #101, Santa Monica, CA 90401 | 2011-09-07 |
| 1295014603 | Richard James Rauth | Dentist | 1234 Seventh Street, Suite 3, Santa Monica, CA 90401 | 2011-08-16 |
| Find all providers in zip 90401 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801407945 | Behavioral Health Services, Inc. | Community/Behavioral Health | 1424 4th St Ste 205, Santa Monica, CA 90401-2352 | 2020-08-12 |
| 1144797697 | Vista Del Mar Child and Family Services | Community/Behavioral Health | 601 Pico Blvd. Ad 508-513, Santa Monica, CA 90405-1224 | 2018-11-01 |
| 1063878510 | Clare Matrix | Community/Behavioral Health | 1002 Pico Blvd, Santa Monica, CA 90405-1416 | 2016-01-13 |
| 1003159203 | Step By Step Edu-play | Community/Behavioral Health | 1412 14th St, Santa Monica, CA 90404-2704 | 2013-04-05 |
| 1912242413 | Early Start Preschools | Community/Behavioral Health | 2505 Lincoln Blvd, Santa Monica, CA 90405-3817 | 2012-12-10 |
| 1376800722 | The People Concern | Community/Behavioral Health | 1749 14th St, Santa Monica, CA 90404-4342 | 2012-04-23 |
| 1477829786 | Step-by-step Edu Play Programs | Community/Behavioral Health | 1814 14th St, 203, Santa Monica, CA 90404-7028 | 2012-03-30 |
| 1376811992 | The People Concern | Community/Behavioral Health | 503 Olympic Blvd, Santa Monica, CA 90401-3311 | 2011-12-09 |
| 1073804738 | Clare Matrix | Community/Behavioral Health | 1020 Pico Blvd, Santa Monica, CA 90405-1416 | 2011-04-28 |
| 1043416993 | St. Joseph Center | Community/Behavioral Health | 1527 4th St Fl 2, Santa Monica, CA 90401 | 2007-06-26 |
| Find all providers in SANTA MONICA | ||||
| City | SANTA MONICA |
| Zip Code | 90401 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.