MEDICARE: SHERMAN OAKS MENTAL HEALTH GROUP GP

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		CA

General Provider Information

NPI Number	:	1477961142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERMAN OAKS MENTAL HEALTH GROUP GP

Provider Business Mailing Address
First Line	:	14724 VENTURA BLVD STE 1100
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-3511
Country	:	US
Telephone Number	:	818-995-8292
Fax Number	:

Provider Business Practice Location Address
First Line	:	14724 VENTURA BLVD STE 1100
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-3511
Country	:	US
Telephone Number	:	818-995-8292
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	KELLY CRAIG JONES
Credential	:	LCSW
Telephone Number	:	818-995-8292

Provider Enumeration Date	:	07/25/2014
Last Update Date	:	07/25/2014

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