Provider Demographics
NPI:1023773009
Name:ADEWALE PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:ADEWALE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEWALE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:323-633-3892
Mailing Address - Street 1:1055 E COLORADO BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2371
Mailing Address - Country:US
Mailing Address - Phone:323-633-3892
Mailing Address - Fax:
Practice Address - Street 1:1055 E COLORADO BLVD STE 500
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2371
Practice Address - Country:US
Practice Address - Phone:323-633-3892
Practice Address - Fax:626-240-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health