MEDICARE: JAMES H MCEWEN 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	45637	CA

General Provider Information

NPI Number	:	1750418869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES H MCEWEN LMFT

Provider Business Mailing Address
First Line	:	201 E ANGELENO AVE UNIT 325
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91502-2954
Country	:	US
Telephone Number	:	323-485-0193
Fax Number	:	323-463-0619

Provider Business Practice Location Address
First Line	:	550 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1912
Country	:	US
Telephone Number	:	323-769-7129
Fax Number	:	323-463-0619

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	04/03/2012

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