MEDICARE: FORTH SPACE MARRIAGE & FAMILY THERAPY, INC.

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	:	1730826363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORTH SPACE MARRIAGE & FAMILY THERAPY, INC.

Provider Business Mailing Address
First Line	:	444 N LARCHMONT BLVD STE 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 N LARCHMONT BLVD STE 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3030
Country	:	US
Telephone Number	:	310-601-0311
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RACHEL JONES LINN
Credential	:	MA, LMFT
Telephone Number	:	310-601-0311

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	03/03/2026

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