MEDICARE: MS. JENNIFER DAWN MUSSELMAN 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
2	106H00000X	Marriage & Family Therapist	93511	CA

General Provider Information

NPI Number	:	1538445325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER DAWN MUSSELMAN MFT

Provider Business Mailing Address
First Line	:	11911 SAN VICENTE BLVD STE 240
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6619
Country	:	US
Telephone Number	:	310-614-4660
Fax Number	:

Provider Business Practice Location Address
First Line	:	11911 SAN VICENTE BLVD STE 240
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6619
Country	:	US
Telephone Number	:	310-614-4660
Fax Number	:

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

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	07/10/2016

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