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NPI Code Detail

MEDICARE: AMY MCMANUS LMFT

MEDICARE: AMY MCMANUS 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 TherapistMFC95725CA

General Provider Information

NPI Number : 1255973517
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY MCMANUS LMFT
Provider Business Mailing Address
First Line : 475 WASHINGTON BLVD
Second Line :
City : MARINA DEL REY
State : CA
Zip : 90292-5287
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 475 WASHINGTON BLVD
Second Line :
City : MARINA DEL REY
State : CA
Zip : 90292-5287
Country : US
Telephone Number : 323-999-1537
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2019
Last Update Date : 10/08/2019

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