NPIMap

Organization Active NPI

Eb Psychotherapy, Inc

  • Clinical Psychologist
  • Los Angeles, CA
National Provider Identifier
1699009753
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY22542 Issued in CA
Legal business name
EB PSYCHOTHERAPY, INC
Practice address
2001 S Barrington Ave Ste 314
Los Angeles, CA 90025-5379
Phone
(310) 999-9683
Fax
(213) 261-9887
NPI assigned
Sep 22, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

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

Authorized official

Name
Dr. Eleni BagourdiNPI 1447490958
Title
Clinical Director
Phone
(310) 999-9683

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X PSY22542 CA Primary

Addresses

Primary practice location

2001 S Barrington Ave Ste 314
Los Angeles, CA 90025-5379

Mailing address

2001 S Barrington Ave Ste 314
Los Angeles, CA 90025-5379
Phone (310) 999-9683

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091201000317 CA Part B Supplier - Clinic/Group Practice 8527107705 Receives reassigned benefits from 9 practitioners
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1253577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622505600000",
    "number": "1699009753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S BARRINGTON AVE STE 314",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900255379",
            "telephone_number": "310-999-9683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S BARRINGTON AVE STE 314",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900255379",
            "telephone_number": "310-999-9683",
            "fax_number": "213-261-9887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EB PSYCHOTHERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-22",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A",
        "authorized_official_last_name": "BAGOURDI",
        "authorized_official_first_name": "ELENI",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "310-999-9683",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY22542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.