MEDICARE: ANDREA SHIRLEY MFT

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	106H00000X	Marriage & Family Therapist	42752	CA

General Provider Information

NPI Number	:	1265567481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA SHIRLEY MFT

Provider Business Mailing Address
First Line	:	6601 CENTER DRIVE WEST
Second Line	:	SUITE 500, HOWARD HUGHES CENTER
City	:	LOS ANGELES
State	:	CA
Zip	:	90045
Country	:	US
Telephone Number	:	310-342-8290
Fax Number	:	310-342-8209

Provider Business Practice Location Address
First Line	:	6601 CENTER DRIVE WEST
Second Line	:	SUITE 500, HOWARD HUGHES CENTER
City	:	LOS ANGELES
State	:	CA
Zip	:	90045
Country	:	US
Telephone Number	:	310-342-8290
Fax Number	:	310-342-8209

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/08/2007

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