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General NPI Number Information
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NPI Number | 1043079551
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Entity Type | Individual
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Provider Name | NICOLE PASCAVIS AMFT, APCC
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Gender | Female
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Dates
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Enumeration Date | 03/18/2024
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 11949 JEFFERSON BLVD STE 102
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City | CULVER CITY
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State | CA
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Zip | 90230-6336
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Country | US
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Telephone | 323-688-6771
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Fax |
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Provider Business Mailing Address
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Address Line | 3571 BEETHOVEN ST APT 2
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City | LOS ANGELES
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State | CA
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Zip | 90066-3050
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Country | US
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Telephone | 480-882-8663
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 13897
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 139688
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License Number State | CA
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