MEDICARE: CORY SCHNEIDER LMFT

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	88014	CA

General Provider Information

NPI Number	:	1053776534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORY SCHNEIDER LMFT

Provider Business Mailing Address
First Line	:	1317 N SWEETZER AVE
Second Line	:	#3
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-2613
Country	:	US
Telephone Number	:	213-840-5938
Fax Number	:

Provider Business Practice Location Address
First Line	:	1317 N SWEETZER AVE
Second Line	:	#3
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-2613
Country	:	US
Telephone Number	:	213-840-5938
Fax Number	:

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

Provider Enumeration Date	:	12/28/2015
Last Update Date	:	12/28/2015

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