MEDICARE: ERIN ROALSTAD-BOSSIN M.A., LMFT

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	MFC 53174	CA

General Provider Information

NPI Number	:	1720421670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN ROALSTAD-BOSSIN M.A., LMFT

Provider Business Mailing Address
First Line	:	10736 JEFFERSON BLVD # 713
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4933
Country	:	US
Telephone Number	:	310-480-1403
Fax Number	:

Provider Business Practice Location Address
First Line	:	4248 OVERLAND AVE STE 240
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-3701
Country	:	US
Telephone Number	:	310-480-1403
Fax Number	:

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

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	05/17/2022

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