=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730434499
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANTAGE COUNSELING SERVICES, A MARRIAGE & FAMILY THERAPY CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2012
-----------------------------------------------------
Last Update Date | 07/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6205 LAUREL CANYON BLVD
-----------------------------------------------------
City | NORTH HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91606-3210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-763-6616
-----------------------------------------------------
Fax | 818-508-5540
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6205 LAUREL CANYON BLVD
-----------------------------------------------------
City | NORTH HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91606-3210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-763-6616
-----------------------------------------------------
Fax | 818-508-5540
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SHEKIBA QUDRAT
-----------------------------------------------------
Credential | M.A.
-----------------------------------------------------
Telephone | 818-763-6615
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC 44813
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------