MEDICARE: THE TBH MOVEMENT, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1407649247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE TBH MOVEMENT, INC.

Provider Business Mailing Address
First Line	:	553 N PACIFIC COAST HWY
Second Line	:	PMB 337B
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-2163
Country	:	US
Telephone Number	:	424-262-2454
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 S PACIFIC COAST HWY STE 205A
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5611
Country	:	US
Telephone Number	:	424-262-2454
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	FONDA TOUSHIGE
Credential	:	LCSW
Telephone Number	:	424-262-2454

Provider Enumeration Date	:	05/24/2025
Last Update Date	:	05/24/2025

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Directions to “THE TBH MOVEMENT, INC. ” Practice Location

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