MEDICARE: MR. CALVIN EUBANKS POWELL LMFT

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	LMFT37386	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MFC 37386	OTHER	CA	MFT LICENSE NUMBER

General Provider Information

NPI Number	:	1750415659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CALVIN EUBANKS POWELL LMFT

Provider Business Mailing Address
First Line	:	401 SHIRLEY PL APT 110
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-4134
Country	:	US
Telephone Number	:	310-908-2725
Fax Number	:	888-901-4156

Provider Business Practice Location Address
First Line	:	2001 S BARRINGTON AVE
Second Line	:	APT 203
City	:	WEST LOS ANGELES
State	:	CA
Zip	:	90025-5363
Country	:	US
Telephone Number	:	310-908-2725
Fax Number	:	888-901-4156

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	05/28/2016

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