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General NPI Number Information
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NPI Number | 1487722658
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Entity Type | Individual
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Provider Name | MARTIN COLEMAN NOVELL MARRIAGE FAMILY THER
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Gender | Male
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 2001 S BARRINGTON AVE SUITE 209
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City | LOS ANGELES
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State | CA
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Zip | 90025-5363
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Country | US
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Telephone | 310-250-4556
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Fax | 310-451-7746
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Provider Business Mailing Address
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Address Line | 522 SAN VICENTE BLVD MARTIN NOVELL UNIT G
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City | SANTA MONICA
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State | CA
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Zip | 90402-1839
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Country | US
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Telephone | 310-250-4556
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Fax | 310-451-7746
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 34918
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License Number State | CA
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