MEDICARE: MARIO PALACIOS THERAPY

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	:	1770048951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIO PALACIOS THERAPY

Provider Business Mailing Address
First Line	:	3824 MOTOR AVE APT 21
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-3156
Country	:	US
Telephone Number	:	310-384-3922
Fax Number	:

Provider Business Practice Location Address
First Line	:	5556 S CENTINELA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-6912
Country	:	US
Telephone Number	:	310-384-3922
Fax Number	:

Authorized Official
Title or Position	:	LMFT
Name	:	MR. MARIO FERNANDO PALACIOS
Credential	:	LMFT
Telephone Number	:	310-384-3922

Provider Enumeration Date	:	02/01/2019
Last Update Date	:	07/05/2023

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Directions to “MARIO PALACIOS THERAPY ” Practice Location

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