MEDICARE: EB MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION

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

General Provider Information

NPI Number	:	1699623512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EB MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	4705 LAUREL CANYON BLVD STE 306
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-5940
Country	:	US
Telephone Number	:	213-516-2480
Fax Number	:

Provider Business Practice Location Address
First Line	:	4705 LAUREL CANYON BLVD STE 306
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-5940
Country	:	US
Telephone Number	:	213-516-2480
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EMANUELA BUCHALTER
Credential	:	LMFT
Telephone Number	:	213-516-2480

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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