MEDICARE: MRS. ADI GORAL M.A.

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

General Provider Information

NPI Number	:	1457687840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ADI GORAL M.A.

Provider Business Mailing Address
First Line	:	22704 VENTURA BLVD
Second Line	:	#474
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-1333
Country	:	US
Telephone Number	:	818-519-1371
Fax Number	:

Provider Business Practice Location Address
First Line	:	22704 VENTURA BLVD
Second Line	:	#474
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-1333
Country	:	US
Telephone Number	:	818-519-1371
Fax Number	:

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

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	03/02/2017

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