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NPI Code Detail

MEDICARE: MR. BOOKER TK WAUGH

MEDICARE: MR. BOOKER TK WAUGH
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1063692952
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BOOKER TK WAUGH
Provider Business Mailing Address
First Line : 1500 S MCDONNELL AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90040-5623
Country : US
Telephone Number : 323-981-4356
Fax Number : 323-881-6733
Provider Business Practice Location Address
First Line : 1500 S MCDONNELL AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90040-5623
Country : US
Telephone Number : 323-981-4356
Fax Number : 323-881-6733
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2007
Last Update Date : 11/07/2007

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