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NPI Code Detail

MEDICARE: DEANNA MCCOLLUM

MEDICARE: DEANNA MCCOLLUM
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
1171M00000XCase Manager/Care CoordinatorCA
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1245905876
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEANNA MCCOLLUM
Provider Business Mailing Address
First Line : 2116 ARLINGTON AVE STE 100
Second Line :
City : LOS ANGELES
State : CA
Zip : 90018-1300
Country : US
Telephone Number : 323-334-9000
Fax Number : 323-334-4437
Provider Business Practice Location Address
First Line : 1749 14TH ST
Second Line :
City : SANTA MONICA
State : CA
Zip : 90404-4342
Country : US
Telephone Number : 213-760-4362
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2021
Last Update Date : 01/17/2024

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Directions to “ DEANNA MCCOLLUM ” Practice Location

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