MEDICARE: JESSICA MARIE MAGENHEIMER 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
1	106H00000X	Marriage & Family Therapist	T1718	OR
2	106H00000X	Marriage & Family Therapist	LMFT 84128	CA

General Provider Information

NPI Number	:	1356661227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARIE MAGENHEIMER LMFT

Provider Business Mailing Address
First Line	:	2219 MAIN ST # 179
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-2217
Country	:	US
Telephone Number	:	310-800-1630
Fax Number	:

Provider Business Practice Location Address
First Line	:	2219 MAIN ST # 179
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-2217
Country	:	US
Telephone Number	:	310-800-1630
Fax Number	:

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

Provider Enumeration Date	:	06/02/2010
Last Update Date	:	02/13/2021

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