MEDICARE: ABUNDANCE PSYCHOTHERAPY CENTER INC

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	LMFT98291	CA
2	1041C0700X	Clinical Social Worker	LCSW28582	CA

General Provider Information

NPI Number	:	1205335445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANCE PSYCHOTHERAPY CENTER INC

Provider Business Mailing Address
First Line	:	4221 WILSHIRE BLVD STE 170-16
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3519
Country	:	US
Telephone Number	:	213-441-6780
Fax Number	:

Provider Business Practice Location Address
First Line	:	4221 WILSHIRE BLVD STE 170-16
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3519
Country	:	US
Telephone Number	:	213-441-6780
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/THERAPIST
Name	:	CHRISTINE CHAE
Credential	:	LCSW
Telephone Number	:	213-441-6780

Provider Enumeration Date	:	02/02/2018
Last Update Date	:	10/14/2021

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