MEDICARE: MAURA ELIZABETH PHELPS MT-BC

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	225A00000X	Music Therapist	16074

General Provider Information

NPI Number	:	1023724218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURA ELIZABETH PHELPS MT-BC

Provider Business Mailing Address
First Line	:	1611 XIMENO AVE APT 136
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-2135
Country	:	US
Telephone Number	:	360-259-4432
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 XIMENO AVE APT 136
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-2135
Country	:	US
Telephone Number	:	360-259-4432
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	01/30/2023

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