MEDICARE: SOUTHERN CALIFORNIA COUNSELING CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033818067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN CALIFORNIA COUNSELING CENTER

Provider Business Mailing Address
First Line	:	5615 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3835
Country	:	US
Telephone Number	:	323-937-1344
Fax Number	:

Provider Business Practice Location Address
First Line	:	5615 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3835
Country	:	US
Telephone Number	:	323-937-1344
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MICHAEL KOCH
Credential	:
Telephone Number	:	323-937-1344

Provider Enumeration Date	:	02/28/2023
Last Update Date	:	02/28/2023

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