MEDICARE: MS. EILEEN SHOALS 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	77475	CA

General Provider Information

NPI Number	:	1770943417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EILEEN SHOALS LMFT

Provider Business Mailing Address
First Line	:	5501 NEWCASTLE AVE APT 214
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-2173
Country	:	US
Telephone Number	:	310-936-6378
Fax Number	:

Provider Business Practice Location Address
First Line	:	1772 S ROBERTSON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-4316
Country	:	US
Telephone Number	:	310-694-5590
Fax Number	:

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

Provider Enumeration Date	:	02/23/2016
Last Update Date	:	02/23/2016

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