MEDICARE: DESHAWN DENISE EPHRIAM

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1376880864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESHAWN DENISE EPHRIAM

Provider Business Mailing Address
First Line	:	422 E COLDEN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-4319
Country	:	US
Telephone Number	:	818-903-0277
Fax Number	:

Provider Business Practice Location Address
First Line	:	1841 W IMPERIAL HWY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-5021
Country	:	US
Telephone Number	:	323-750-2850
Fax Number	:

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

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	01/03/2013

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Directions to “ DESHAWN DENISE EPHRIAM ” Practice Location

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