Healthcare Provider Details

I. General information

NPI: 1740136779
Provider Name (Legal Business Name): MADISON HO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADISON PITTS

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27118 SILVER SPUR RD
ROLLING HILLS ESTATES CA
90274-2300
US

IV. Provider business mailing address

1653 7TH ST PO BOX 1301
SANTA MONICA CA
90401
US

V. Phone/Fax

Practice location:
  • Phone: 323-744-1217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: