MEDICARE: JEFFERY PATRICK EPPS

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
2	103TF0200X	Forensic Psychologist	PSB94025816	CA

General Provider Information

NPI Number	:	1386212389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY PATRICK EPPS

Provider Business Mailing Address
First Line	:	2728 W 54TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-2644
Country	:	US
Telephone Number	:	661-238-6075
Fax Number	:

Provider Business Practice Location Address
First Line	:	2728 W 54TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-2644
Country	:	US
Telephone Number	:	213-500-1141
Fax Number	:

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

Provider Enumeration Date	:	06/15/2021
Last Update Date	:	11/02/2021

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Directions to “ JEFFERY PATRICK EPPS ” Practice Location

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