MEDICARE: MELISSA LOX MFT/INTERN

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
2	106H00000X	Marriage & Family Therapist	IMF60357	CA

General Provider Information

NPI Number	:	1962557330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LOX MFT/INTERN

Provider Business Mailing Address
First Line	:	3580 WILSHIRE BLVD
Second Line	:	8TH FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2501
Country	:	US
Telephone Number	:	213-637-5000
Fax Number	:	213-637-5001

Provider Business Practice Location Address
First Line	:	3580 WILSHIRE BLVD
Second Line	:	8TH FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2501
Country	:	US
Telephone Number	:	213-637-5000
Fax Number	:	213-637-5001

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	04/18/2011

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