MEDICARE: PRINCESS AUDIA OUBRE LMFT

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	158252	CA

General Provider Information

NPI Number	:	1528623428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRINCESS AUDIA OUBRE LMFT

Provider Business Mailing Address
First Line	:	2052 S BUNDY DR # 1126
Second Line	:
City	:	WEST LOS ANGELES
State	:	CA
Zip	:	90025-6102
Country	:	US
Telephone Number	:	949-833-2237
Fax Number	:

Provider Business Practice Location Address
First Line	:	2052 S BUNDY DR # 1126
Second Line	:
City	:	WEST LOS ANGELES
State	:	CA
Zip	:	90025-6102
Country	:	US
Telephone Number	:	562-537-2223
Fax Number	:

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

Provider Enumeration Date	:	05/06/2019
Last Update Date	:	09/30/2025

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