MEDICARE: MARIAN MAYA THOMPSON LMFTA, BHSS

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	172V00000X	Community Health Worker
2	106H00000X	Marriage & Family Therapist	MFTA.MG.70142686	WA
3	174H00000X	Health Educator
4	374J00000X	Doula

General Provider Information

NPI Number	:	1538880745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAN MAYA THOMPSON LMFTA, BHSS

Provider Business Mailing Address
First Line	:	2355 WESTWOOD BLVD UNIT 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2355 WESTWOOD BLVD UNIT 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2109
Country	:	US
Telephone Number	:	323-205-5436
Fax Number	:

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

Provider Enumeration Date	:	09/06/2022
Last Update Date	:	06/24/2026

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