MEDICARE: COR COUNSELING MARRIAGE AND FAMILY THERAPIST

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1801772868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COR COUNSELING MARRIAGE AND FAMILY THERAPIST

Provider Business Mailing Address
First Line	:	5723 STAR LN
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-3961
Country	:	US
Telephone Number	:	310-272-6821
Fax Number	:

Provider Business Practice Location Address
First Line	:	5723 STAR LN
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-3961
Country	:	US
Telephone Number	:	310-272-6821
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	NICOLE ANAVIM
Credential	:
Telephone Number	:	310-272-6821

Provider Enumeration Date	:	08/14/2025
Last Update Date	:	08/14/2025

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