Healthcare Provider Details

I. General information

NPI: 1487199626
Provider Name (Legal Business Name): CECCILY BEDNASH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2016
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 DON TOMASO DR APT 1
LOS ANGELES CA
90008-5319
US

IV. Provider business mailing address

4001 DON TOMASO DR APT 1
LOS ANGELES CA
90008-5319
US

V. Phone/Fax

Practice location:
  • Phone: 602-299-4679
  • Fax:
Mailing address:
  • Phone: 602-299-4679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT118797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: