MEDICARE: M. ATTARIAN A MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1114527041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M. ATTARIAN A MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	433 N CAMDEN DR STE 400
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	433 N CAMDEN DR STE 400
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4408
Country	:	US
Telephone Number	:	310-691-9416
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MONA ATTARIAN
Credential	:	LMFT
Telephone Number	:	310-691-9416

Provider Enumeration Date	:	10/29/2020
Last Update Date	:	10/29/2020

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