MEDICARE: ADAM THOMAS COLSON LCSW

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	21017	CA

General Provider Information

NPI Number	:	1912692286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM THOMAS COLSON LCSW

Provider Business Mailing Address
First Line	:	1152 GREENACRE AVE
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5706
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1152 GREENACRE AVE
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5706
Country	:	US
Telephone Number	:	310-850-2379
Fax Number	:

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

Provider Enumeration Date	:	04/11/2023
Last Update Date	:	04/11/2023

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