MEDICARE: SHEKINAH GLORY FAMILY COUNSELING SERVICES, INC.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1245921113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEKINAH GLORY FAMILY COUNSELING SERVICES, INC.

Provider Business Mailing Address
First Line	:	5176 W SLAUSON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90056-1641
Country	:	US
Telephone Number	:	323-573-5788
Fax Number	:

Provider Business Practice Location Address
First Line	:	5176 W SLAUSON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90056-1641
Country	:	US
Telephone Number	:	323-573-5788
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LISA M. DOZIER
Credential	:	LMFT
Telephone Number	:	323-573-5788

Provider Enumeration Date	:	05/19/2023
Last Update Date	:	05/19/2023

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