MEDICARE: KATHIE ADAMS MA, MFT

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	106H00000X	Marriage & Family Therapist	MFC41403	CA

General Provider Information

NPI Number	:	1073777207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHIE ADAMS MA, MFT

Provider Business Mailing Address
First Line	:	1628 W 25TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-1528
Country	:	US
Telephone Number	:	310-713-3114
Fax Number	:

Provider Business Practice Location Address
First Line	:	1628 W 25TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-1528
Country	:	US
Telephone Number	:	310-713-3114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	12/08/2011

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