Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TA0700X | Adult Development & Aging Psychologist | ||
N | 103G00000X | Clinical Psychologist | PSY29845 | CA |
N | 103TC0700X | Clinical Psychologist | PSY29845 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
N | 103TE1100X | Exercise & Sports Psychologist | ||
N | 103TF0000X | Family Psychologist | ||
N | 103TH0004X | Health Psychologist | ||
N | 103TP2701X | Group Psychotherapist | ||
N | 103TR0400X | Rehabilitation Psychologist | ||
N | 103TS0200X | School Psychologist | ||
N | 225400000X | Rehabilitation Practitioner |
NPI | 1043497415 |
---|---|
Provider Name | Dr. Mantsha Boikanyo |
First Address | Los Angeles, CA 90034-3710 |
Second Address | Los Angeles, CA 90025-5379 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2008 |
Last Update Date | 12/09/2019 |