MEDICARE: LOUIS FREDERICK

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	:	1790374460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUIS FREDERICK

Provider Business Mailing Address
First Line	:	1303 HEPNER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-2436
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5615 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3835
Country	:	US
Telephone Number	:	323-937-1344
Fax Number	:

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

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	01/15/2021

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Directions to “ LOUIS FREDERICK ” Practice Location

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