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NPI Code Detail

MEDICARE: MS. MARICSA S. EVANS M.A., LMFT

MEDICARE: MS. MARICSA S. EVANS M.A., 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
1106H00000XMarriage & Family Therapist48838CA

General Provider Information

NPI Number : 1235256652
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARICSA S. EVANS M.A., LMFT
Provider Business Mailing Address
First Line : 711 S NEW HAMPSHIRE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90005-1831
Country : US
Telephone Number : 213-385-5100
Fax Number : 323-566-1638
Provider Business Practice Location Address
First Line : 711 S NEW HAMPSHIRE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90005-1831
Country : US
Telephone Number : 213-385-5100
Fax Number : 323-566-1638
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 08/01/2011

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