MEDICARE: CORINNE EISENHARDT

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	0017294	CO
2	101YM0800X	Mental Health Counselor	6401013640	MI
3	101YM0800X	Mental Health Counselor	4467	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4467	OTHER	CA	LICENSE PROFESSIONAL CLINICAL COUNSELOR
2	6401013640	OTHER	MI	LICENSED PROFESSIONAL COUNSELOR
3	0017294	OTHER	CO	STATE LICENSING BOARD

General Provider Information

NPI Number	:	1487080412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORINNE EISENHARDT

Provider Business Mailing Address
First Line	:	1910 HILLHURST AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-2712
Country	:	US
Telephone Number	:	818-660-5862
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 HILLHURST AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-2712
Country	:	US
Telephone Number	:	818-660-5862
Fax Number	:

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

Provider Enumeration Date	:	09/23/2013
Last Update Date	:	03/03/2022

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Directions to “ CORINNE EISENHARDT ” Practice Location

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