MEDICARE: STEPHANIE MARIE UNSON

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	100986	CA

General Provider Information

NPI Number	:	1417594227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MARIE UNSON

Provider Business Mailing Address
First Line	:	4470 W SUNSET BLVD UNIT 1339
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4470 W SUNSET BLVD UNIT 1339
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6302
Country	:	US
Telephone Number	:	661-435-6354
Fax Number	:

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

Provider Enumeration Date	:	11/30/2019
Last Update Date	:	08/08/2022

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