MEDICARE: WALTER HIRSCH 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	119788	CA

General Provider Information

NPI Number	:	1912525056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER HIRSCH LMFT

Provider Business Mailing Address
First Line	:	PO BOX 3323
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90408-3323
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11835 W OLYMPIC BLVD STE 405
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-5002
Country	:	US
Telephone Number	:	424-322-9929
Fax Number	:

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

Provider Enumeration Date	:	07/06/2020
Last Update Date	:	07/06/2020

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Directions to “ WALTER HIRSCH LMFT” Practice Location

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