MEDICARE: ADVANTAGE COUNSELING SERVICES, A MARRIAGE & FAMILY THERAPY 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	MFC 44813	CA

General Provider Information

NPI Number	:	1730434499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE COUNSELING SERVICES, A MARRIAGE & FAMILY THERAPY CORPORATION

Provider Business Mailing Address
First Line	:	6205 LAUREL CANYON BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3210
Country	:	US
Telephone Number	:	818-763-6616
Fax Number	:	818-508-5540

Provider Business Practice Location Address
First Line	:	6205 LAUREL CANYON BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3210
Country	:	US
Telephone Number	:	818-763-6616
Fax Number	:	818-508-5540

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHEKIBA QUDRAT
Credential	:	M.A.
Telephone Number	:	818-763-6615

Provider Enumeration Date	:	07/18/2012
Last Update Date	:	07/18/2012

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