MEDICARE: SEVEN DUCKS 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1720803174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEVEN DUCKS THERAPY

Provider Business Mailing Address
First Line	:	6718 VAN NOORD AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1105
Country	:	US
Telephone Number	:	574-551-0710
Fax Number	:

Provider Business Practice Location Address
First Line	:	6718 VAN NOORD AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1105
Country	:	US
Telephone Number	:	574-551-0710
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	BRITTANY DECKER KUSSEROW
Credential	:	LMFT
Telephone Number	:	574-551-0710

Provider Enumeration Date	:	11/20/2024
Last Update Date	:	11/20/2024

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Directions to “SEVEN DUCKS THERAPY ” Practice Location

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