MEDICARE: MY ABUNDANT LIFE NOW COUNSELING SERVICES

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1972238558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY ABUNDANT LIFE NOW COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	2436 E 4TH ST # 1370
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-1156
Country	:	US
Telephone Number	:	424-396-5139
Fax Number	:

Provider Business Practice Location Address
First Line	:	3595 SANTA FE AVE SPC 166
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90810-4356
Country	:	US
Telephone Number	:	310-292-8894
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/CEO
Name	:	MRS. CHERYL D WILLIAMS
Credential	:	LMFT
Telephone Number	:	310-292-8894

Provider Enumeration Date	:	07/19/2022
Last Update Date	:	07/19/2022

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