MEDICARE: MISS MARIAM VANOUNTS 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	47199	CA
2	106H00000X	Marriage & Family Therapist	46212	CA

General Provider Information

NPI Number	:	1104961895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIAM VANOUNTS LMFT

Provider Business Mailing Address
First Line	:	326 E FAIRVIEW AVE APT 2
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91207-1998
Country	:	US
Telephone Number	:	818-406-7979
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 N CENTRAL AVE # 1763
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-1422
Country	:	US
Telephone Number	:	818-406-7979
Fax Number	:

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	10/25/2020

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Directions to “ MISS MARIAM VANOUNTS LMFT” Practice Location

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