MEDICARE: ELLY G WOLF MA, MFT

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	101YM0800X	Mental Health Counselor	41968	CA

General Provider Information

NPI Number	:	1821507351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLY G WOLF MA, MFT

Provider Business Mailing Address
First Line	:	2550 HONOLULU AVE STE 103
Second Line	:
City	:	MONTROSE
State	:	CA
Zip	:	91020-1859
Country	:	US
Telephone Number	:	818-802-7465
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 HONOLULU AVE STE 103
Second Line	:
City	:	MONTROSE
State	:	CA
Zip	:	91020-1859
Country	:	US
Telephone Number	:	818-802-7465
Fax Number	:

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

Provider Enumeration Date	:	09/27/2017
Last Update Date	:	07/21/2022

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