MEDICARE: MARRIAGE COUNSELING CTR SEXUAL HEALTH

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	:	1194411256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARRIAGE COUNSELING CTR SEXUAL HEALTH

Provider Business Mailing Address
First Line	:	2660 TOWNSGATE RD STE 520
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-5712
Country	:	US
Telephone Number	:	805-308-9800
Fax Number	:	805-230-2210

Provider Business Practice Location Address
First Line	:	2660 TOWNSGATE RD STE 520
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-5712
Country	:	US
Telephone Number	:	805-308-9800
Fax Number	:	805-230-2210

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MR. JACKSON DELORD SOUSA
Credential	:	LMFT
Telephone Number	:	805-279-2088

Provider Enumeration Date	:	04/12/2023
Last Update Date	:	08/25/2025

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