EXECUTIVE MENTAL HEALTH, INC. (NPI# 1275670036) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275670036 |
| Entity Type | Organization |
| Organization Name | EXECUTIVE MENTAL HEALTH, INC. |
| Practice Address |
11835 W Olympic Blvd Ste 1265e Los Angeles CA 90064-5814 |
| Practice Telephone | 3102734843 |
| Practice Fax Number | 3102735056 |
| Mailing Telephone | 3102734843 |
| Mailing Fax Number | 3102735056 |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2020-02-27 |
| Authorized Official Name | DR. ARI DAVID KALECHSTEIN (PRESIDENT/ OWNER) |
| Authorized Official Telephone | 3102734843 |
| Authorized Official Credential | PH.D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
PSY14872 | CA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 546788 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 10801 National Blvd, Suite 611, Los Angeles, CA 900644139 | 3102734843 | 3102735056 |
| Street Address |
11835 W OLYMPIC BLVD STE 1265E |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90064-5814 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689600744 | Jennifer Lee Sharples | Psychologist | 11835 W Olympic Blvd Ste 1265e, Los Angeles, CA 90064-5814 | 2006-06-23 |
| 1215549613 | Ana Martinez De Andino | Psychologist | 11835 W Olympic Blvd Ste 1265e, Los Angeles, CA 90064-5814 | 2020-08-18 |
| 1619508249 | Adrianna Elyse Holness | Psychologist | 11835 W Olympic Blvd Ste 1265e, Los Angeles, CA 90064-5814 | 2020-02-02 |
| 1992283188 | Melissa Matos | Psychologist | 11835 W Olympic Blvd Ste 1265e, Los Angeles, CA 90064 | 2018-07-31 |
| 1699279679 | Kenny A Karyadi | Clinical Neuropsychologist | 11835 W Olympic Blvd Ste 1265e, Los Angeles, CA 90064 | 2018-03-22 |
| 1356849459 | Audrey E Martinez | Psychologist | 11835 W Olympic Blvd Ste 1265e, Los Angeles, CA 90064 | 2018-01-24 |
| 1154837300 | Kristina Marie Reynolds | Psychologist | 11835 W Olympic Blvd Ste 1265e, Los Angeles, CA 90064 | 2017-12-26 |
| 1366953986 | Jennefer S Ho | Psychologist | 11835 W Olympic Blvd Ste 1265e, Los Angeles, CA 90064 | 2017-10-23 |
| 1184154726 | Earl Clare Thorndyke IIi | Clinical Neuropsychologist | 11835 W Olympic Blvd Ste 1265e, Los Angeles, CA 90064 | 2017-06-15 |
| 1457880809 | Jayce Long | Psychologist | 11835 W Olympic Blvd Ste 1265e, Los Angeles, CA 90064-5814 | 2017-06-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134727597 | Barbara K. Polland | Marriage & Family Therapist | 10533 Rountree Rd., Los Angeles, CA 90064 | 2020-10-16 |
| 1912542994 | Reproductive Medicine Associates of Socal Ambulatory Surgery Center | Clinic/Center | 11500 W Olympic Blvd, Ste# 150, Los Angeles, CA 90064 | 2019-11-13 |
| 1376022012 | Payersdirect, Inc. | Radiology | 11845 W Olympic Blvd Ste 1100w, Los Angeles, CA 90064 | 2018-08-13 |
| 1013404136 | Jeannie Wakamatsu | Dietitian, Registered | 10312 Almayo Ave., Suite 6, Los Angeles, CA 90064 | 2018-04-13 |
| 1487153474 | Victor Louie | Behavior Technician | 11835 W Olympic Blvd Suite 140e, Los Angeles, CA 90064 | 2018-02-06 |
| 1538683842 | Ana Grinfeld | Behavioral Analyst | 11835 W Olympic Blvd Ste 140e, Los Angeles, CA 90064 | 2017-07-28 |
| 1407386089 | Ovsanna Stepanyan | Rehabilitation Practitioner | 11080 W Olimpic Blvd, La, CA 90064 | 2017-06-15 |
| 1952768012 | Grace Gayles | Behavioral Analyst | 11835 W. Olympic Blvd., Suite 140e, Los Angeles, CA 90064 | 2016-01-20 |
| 1669841003 | Jessica Hildebrandt | Occupational Therapy Assistant | 2446 S Westgate Ave, Los Angeles, CA 90064 | 2015-09-16 |
| 1033592571 | Joshua Busse | Family Medicine | 11845 Olympic Boulevard, Los Angeles, CA 90064 | 2015-07-01 |
| Find all providers in zip 90064 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912506361 | Kathryn A Miller | Counselor | 1965 1/2 N Bronson Ave, Los Angeles, CA 90068-5601 | 2020-10-17 |
| 1669088464 | Bethel Los Angeles Community Development Corporation | Counselor | 7900 S Western Ave, Los Angeles, CA 90047-2715 | 2020-09-17 |
| 1346855244 | Sorenson Psychological and Assessment Services | Counselor | 12301 Wilshire Blvd Ste 413, Los Angeles, CA 90025-1051 | 2020-09-09 |
| 1841800190 | Daniela Sanchez | Counselor | 5081 Borland Rd, Los Angeles, CA 90032-3950 | 2020-08-02 |
| 1649888512 | David John Laing | Counselor | 3100 Riverside Dr Apt 220, Los Angeles, CA 90027-1481 | 2020-07-16 |
| 1366060659 | Amy H Kim | Counselor | 2152 Lemoyne St, Los Angeles, CA 90026-1950 | 2020-07-13 |
| 1083231435 | Leslie Gluck | Counselor | 11835 W Olympic Blvd Ste 815, Los Angeles, CA 90064-5056 | 2020-07-01 |
| 1104441112 | Barbara R Ponse | Counselor | 655 S Dunsmuir Ave Apt 201, Los Angeles, CA 90036-4087 | 2020-06-15 |
| 1033734264 | Shelley Baird Smith | Counselor | 265 S St Andrews Pl, Los Angeles, CA 90004-5029 | 2020-06-12 |
| 1801411566 | Tyler Grant Daly | Counselor | 4221 Wilshire Blvd # 290, Los Angeles, CA 90010-3512 | 2020-06-09 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90064 |
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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.