MEDICARE: ABBY WITHEE, MARRIAGE AND FAMILY THERAPIST, 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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1306508478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABBY WITHEE, MARRIAGE AND FAMILY THERAPIST, INC.

Provider Business Mailing Address
First Line	:	1848 S ELENA AVE STE 105
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5710
Country	:	US
Telephone Number	:	310-243-6580
Fax Number	:

Provider Business Practice Location Address
First Line	:	1848 S ELENA AVE STE 105
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5710
Country	:	US
Telephone Number	:	310-243-6580
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ABIGAIL WITHEE
Credential	:	LMFT
Telephone Number	:	310-243-6580

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	10/06/2021

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