Dr. Wiyatta Psychology Corporation

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

DR. WIYATTA PSYCHOLOGY CORPORATION

Practice address

10153 1/2 Riverside Dr Ste 440
Toluca Lake, CA 91602-2561

Phone

(310) 621-3673

NPI assigned

Oct 8, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Wiyatta Fahnbulleh, PSYDNPI 1750690327

Title

Psychologist

Phone

(310) 621-3673

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wiyatta Fahnbulleh, PSYD

  • Psychologist
  • Toluca Lake, CA
  • NPI 1750690327
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602115200000",
    "number": "1215534565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10153 1/2 RIVERSIDE DR STE 440",
            "city": "TOLUCA LAKE",
            "state": "CA",
            "postal_code": "916022561",
            "telephone_number": "310-621-3673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10153 1/2 RIVERSIDE DR STE 440",
            "city": "TOLUCA LAKE",
            "state": "CA",
            "postal_code": "916022561",
            "telephone_number": "310-621-3673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. WIYATTA PSYCHOLOGY CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-08",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-01",
        "status": "A",
        "authorized_official_last_name": "FAHNBULLEH",
        "authorized_official_first_name": "WIYATTA",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "310-621-3673",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Mental Health Clinic/Center in Toluca Lake, CA
• Providers in Toluca Lake, CA by specialty
• Adult Mental Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.