MEDICARE: AJ R SHENEFELT

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	101YM0800X	Mental Health Counselor
2	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1396184867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AJ R SHENEFELT

Provider Business Mailing Address
First Line	:	1625 W OLYMPIC BLVD STE 600
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3809
Country	:	US
Telephone Number	:	323-999-2404
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 W OLYMPIC BLVD STE 600
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3809
Country	:	US
Telephone Number	:	323-999-2404
Fax Number	:

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

Provider Enumeration Date	:	06/18/2013
Last Update Date	:	07/21/2022

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Directions to “ AJ R SHENEFELT ” Practice Location

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