MEDICARE: ENSO FAMILY THERAPY INC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1437094729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENSO FAMILY THERAPY INC

Provider Business Mailing Address
First Line	:	844 FEDORA ST APT 408
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-6510
Country	:	US
Telephone Number	:	310-902-4813
Fax Number	:

Provider Business Practice Location Address
First Line	:	844 FEDORA ST APT 408
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-6510
Country	:	US
Telephone Number	:	310-902-4813
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ROBERT YOUNG
Credential	:	LMFT
Telephone Number	:	310-902-4813

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/22/2026

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Directions to “ENSO FAMILY THERAPY INC ” Practice Location

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