MEDICARE: MS. EMILY CLAIRE GILBERT M.F.T.

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	52890	CA

General Provider Information

NPI Number	:	1174647754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILY CLAIRE GILBERT M.F.T.

Provider Business Mailing Address
First Line	:	11728 WILSHIRE BLVD APT B801
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6410
Country	:	US
Telephone Number	:	310-386-6583
Fax Number	:

Provider Business Practice Location Address
First Line	:	12099 W WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5882
Country	:	US
Telephone Number	:	310-751-1171
Fax Number	:

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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