MEDICARE: OPEN MIND MARRIAGE AND FAMILY THERAPY

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

General Provider Information

NPI Number	:	1497402671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN MIND MARRIAGE AND FAMILY THERAPY

Provider Business Mailing Address
First Line	:	8411 GLIDER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4220
Country	:	US
Telephone Number	:	310-699-3933
Fax Number	:

Provider Business Practice Location Address
First Line	:	8411 GLIDER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4220
Country	:	US
Telephone Number	:	310-699-3933
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DANIELLE DE VOE
Credential	:	LMFT
Telephone Number	:	310-699-3933

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	03/07/2022

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Directions to “OPEN MIND MARRIAGE AND FAMILY THERAPY ” Practice Location

Language	Start Address	Practice Location

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