MEDICARE: MRS. SIMONA PRUNAU AMFT, APCC

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	149908	CA
2	101YM0800X	Mental Health Counselor	17696	CA

General Provider Information

NPI Number	:	1669287678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SIMONA PRUNAU AMFT, APCC

Provider Business Mailing Address
First Line	:	7473 MULHOLLAND DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-1305
Country	:	US
Telephone Number	:	404-644-0298
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 N HALSTEAD ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3147
Country	:	US
Telephone Number	:	626-921-8283
Fax Number	:

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

Provider Enumeration Date	:	02/08/2025
Last Update Date	:	02/10/2025

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