MEDICARE: MS. SUSAN C SHELL M.A., M.F.T.

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	MFC36240	CA

General Provider Information

NPI Number	:	1518983469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN C SHELL M.A., M.F.T.

Provider Business Mailing Address
First Line	:	12381 WILSHIRE BLVD
Second Line	:	SUITE 205
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1063
Country	:	US
Telephone Number	:	310-395-6639
Fax Number	:	310-826-7500

Provider Business Practice Location Address
First Line	:	12381 WILSHIRE BLVD
Second Line	:	SUITE 205
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1063
Country	:	US
Telephone Number	:	310-395-6639
Fax Number	:	310-826-7500

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/08/2007

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