MEDICARE: MS. MARIA JANE FELLOWS M.A.

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	88837	CA

General Provider Information

NPI Number	:	1952699076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA JANE FELLOWS M.A.

Provider Business Mailing Address
First Line	:	3435 CITY TERRACE DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90063-3732
Country	:	US
Telephone Number	:	510-541-8591
Fax Number	:

Provider Business Practice Location Address
First Line	:	3435 CITY TERRACE DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90063-3732
Country	:	US
Telephone Number	:	510-541-8591
Fax Number	:

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

Provider Enumeration Date	:	07/11/2011
Last Update Date	:	03/07/2017

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