MEDICARE: MANHATTAN VILLAGE COUNSELING CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	46049	CA

General Provider Information

NPI Number	:	1003218181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANHATTAN VILLAGE COUNSELING CENTER, INC.

Provider Business Mailing Address
First Line	:	3201 N SEPULVEDA BLVD
Second Line	:	SUITE H
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2463
Country	:	US
Telephone Number	:	310-545-4422
Fax Number	:	310-545-3322

Provider Business Practice Location Address
First Line	:	3201 N SEPULVEDA BLVD
Second Line	:	SUITE H
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2463
Country	:	US
Telephone Number	:	310-545-4422
Fax Number	:	310-545-3322

Authorized Official
Title or Position	:	PRESIDENT / OWNER
Name	:	MS. JODIE RAE TURNER
Credential	:	LMFT
Telephone Number	:	310-545-4422

Provider Enumeration Date	:	09/20/2014
Last Update Date	:	09/20/2014

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