MEDICARE: MRS. ANNE MARIE PERKINS MFTI

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	67607	CA
2	106H00000X	Marriage & Family Therapist	67607	CA

General Provider Information

NPI Number	:	1528262086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNE MARIE PERKINS MFTI

Provider Business Mailing Address
First Line	:	5893 1/2 DOVERWOOD DR
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-7203
Country	:	US
Telephone Number	:	310-774-1741
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 S BEDFORD ST APT 4
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-1252
Country	:	US
Telephone Number	:	310-774-1741
Fax Number	:

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

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	02/05/2016

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