MEDICARE: KIMBERLY CLAPP MARRIAGE AND FAMIY THERAPIST

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	47049	CA

General Provider Information

NPI Number	:	1386142164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBERLY CLAPP MARRIAGE AND FAMIY THERAPIST

Provider Business Mailing Address
First Line	:	2925 4TH ST APT 29
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-5519
Country	:	US
Telephone Number	:	310-403-9180
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 OCEAN PARK BLVD STE 104
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-3270
Country	:	US
Telephone Number	:	310-403-9180
Fax Number	:

Authorized Official
Title or Position	:	LMFT
Name	:	MS. KIMBERLY ANN CLAPP
Credential	:	LMFT
Telephone Number	:	310-403-9180

Provider Enumeration Date	:	01/26/2018
Last Update Date	:	01/26/2018

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