MEDICARE: FIT METHOD, 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)
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1619393816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIT METHOD, INC.

Provider Business Mailing Address
First Line	:	12011 SAN VICENTE BLVD
Second Line	:	SUITE 510
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-4926
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12011 SAN VICENTE BLVD STE 510
Second Line	:	SUITE 510
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-4947
Country	:	US
Telephone Number	:	866-244-8269
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. SHEILA SHILATI
Credential	:	PSY.D.
Telephone Number	:	866-244-8269

Provider Enumeration Date	:	03/12/2014
Last Update Date	:	06/11/2015

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