MEDICARE: GRETA M COUPER

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	103TC1900X	Counseling Psychologist	158509	CA

General Provider Information

NPI Number	:	1568327690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETA M COUPER

Provider Business Mailing Address
First Line	:	11420 SANTA MONICA BLVD
Second Line	:	25302
City	:	LOS ANGELES
State	:	CA
Zip	:	90025
Country	:	US
Telephone Number	:	310-207-6147
Fax Number	:

Provider Business Practice Location Address
First Line	:	11420 SANTA MONICA BLVD UNIT 25302
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-8823
Country	:	US
Telephone Number	:	310-207-6147
Fax Number	:

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

Provider Enumeration Date	:	12/20/2025
Last Update Date	:	12/20/2025

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Directions to “ GRETA M COUPER ” Practice Location

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