Provider Demographics
NPI:1447078936
Name:F A C T PSYCHOLOGY PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:F A C T PSYCHOLOGY PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-609-3313
Mailing Address - Street 1:23055 SHERMAN WAY UNIT 4482
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91308-7029
Mailing Address - Country:US
Mailing Address - Phone:407-620-1120
Mailing Address - Fax:
Practice Address - Street 1:22606 HAMLIN ST
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-3638
Practice Address - Country:US
Practice Address - Phone:407-620-1120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty