MEDICARE: EATING DISORDER RECOVERY COLLECTIVE

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	:	1316750474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EATING DISORDER RECOVERY COLLECTIVE

Provider Business Mailing Address
First Line	:	1731 N DILLON ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-1113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1731 N DILLON ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-1113
Country	:	US
Telephone Number	:	747-221-7706
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MARRIAGE FAMILY THERAPIST
Name	:	EMILY JODY
Credential	:	LMFT
Telephone Number	:	747-221-7706

Provider Enumeration Date	:	01/30/2025
Last Update Date	:	01/30/2025

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Directions to “EATING DISORDER RECOVERY COLLECTIVE ” Practice Location

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