Provider Demographics
NPI:1023278876
Name:ALAN A MODARRESSI PHD A PROFESSIONAL PSYCHOLOGICAL CORP
Entity type:Organization
Organization Name:ALAN A MODARRESSI PHD A PROFESSIONAL PSYCHOLOGICAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MODARRESSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-861-7226
Mailing Address - Street 1:10800 PARAMOUNT BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3317
Mailing Address - Country:US
Mailing Address - Phone:562-861-7226
Mailing Address - Fax:562-861-6876
Practice Address - Street 1:10800 PARAMOUNT BLVD STE 202
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3317
Practice Address - Country:US
Practice Address - Phone:562-861-7226
Practice Address - Fax:562-861-6876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)