Healthcare Provider Details

I. General information

NPI: 1053826248
Provider Name (Legal Business Name): MADISON BESSER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2017
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W WALNUT ST STE 375
PASADENA CA
91124-2802
US

IV. Provider business mailing address

2621 RUTHERFORD DR
LOS ANGELES CA
90068-3042
US

V. Phone/Fax

Practice location:
  • Phone: 626-395-7100
  • Fax:
Mailing address:
  • Phone: 310-500-7781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number116174
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: