MEDICARE: MODERN MIND THERAPY

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

General Provider Information

NPI Number	:	1598436545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN MIND THERAPY

Provider Business Mailing Address
First Line	:	7615 HAMPTON AVE
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5407
Country	:	US
Telephone Number	:	818-493-9259
Fax Number	:

Provider Business Practice Location Address
First Line	:	7615 HAMPTON AVE
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5407
Country	:	US
Telephone Number	:	818-493-9259
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SARAH TAYLOR
Credential	:	LMFT
Telephone Number	:	818-493-9259

Provider Enumeration Date	:	09/21/2021
Last Update Date	:	08/21/2023

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Directions to “MODERN MIND THERAPY ” Practice Location

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