MEDICARE: ALEXIS DAMON RIBAUT M.A.

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	LMFT90545	CA

General Provider Information

NPI Number	:	1669776696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS DAMON RIBAUT M.A.

Provider Business Mailing Address
First Line	:	9903 SANTA MONICA BLVD # 3000
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-1671
Country	:	US
Telephone Number	:	424-382-9266
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 S BARRINGTON AVE
Second Line	:
City	:	WEST LOS ANGELES
State	:	CA
Zip	:	90025-5363
Country	:	US
Telephone Number	:	424-382-9266
Fax Number	:

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

Provider Enumeration Date	:	01/05/2011
Last Update Date	:	08/24/2016

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