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NPI Code Detail

MEDICARE: MY LA THERAPY

MEDICARE: MY LA THERAPY
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
1261QM0850XAdult Mental Health Clinic/Center
2261QM0855XAdolescent and Children Mental Health Clinic/Center
3261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11568631141OTHERCANPI

General Provider Information

NPI Number : 1124878574
Entity Type Code : Organization
Provider Name (Legal Business Name) : MY LA THERAPY
Provider Business Mailing Address
First Line : 130 OCEAN PARK BLVD UNIT 232
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-3566
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 130 OCEAN PARK BLVD UNIT 232
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-3566
Country : US
Telephone Number : 949-295-0980
Fax Number :
Authorized Official
Title or Position : OWNER/FOUNDER
Name : BROOKE SPROWL
Credential :
Telephone Number : 949-295-0980
Provider Enumeration Date : 03/26/2024
Last Update Date : 04/02/2024

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Directions to “MY LA THERAPY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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