Healthcare Provider Details

I. General information

NPI: 1013521608
Provider Name (Legal Business Name): TALIA MANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 09/02/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8831 VENICE BLVD
LOS ANGELES CA
90034-3223
US

IV. Provider business mailing address

11730 W SUNSET BLVD APT 318
LOS ANGELES CA
90049-2977
US

V. Phone/Fax

Practice location:
  • Phone: 310-204-5200
  • Fax:
Mailing address:
  • Phone: 310-873-8323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: