MEDICARE: JAMES SPENCER GREENE 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	101YM0800X	Mental Health Counselor	MFC29540	CA

General Provider Information

NPI Number	:	1184049116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES SPENCER GREENE MFT

Provider Business Mailing Address
First Line	:	6408 W 6TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4714
Country	:	US
Telephone Number	:	310-464-7465
Fax Number	:

Provider Business Practice Location Address
First Line	:	6408 W 6TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4714
Country	:	US
Telephone Number	:	310-464-7465
Fax Number	:

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

Provider Enumeration Date	:	02/27/2014
Last Update Date	:	02/27/2014

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