MEDICARE: MR. JOHN ADAM MUNTNER MFT

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	52793	CA

General Provider Information

NPI Number	:	1922346683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN ADAM MUNTNER MFT

Provider Business Mailing Address
First Line	:	10736 JEFFERSON BLVD
Second Line	:	#878
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4933
Country	:	US
Telephone Number	:	323-459-2383
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 OCEAN PARK BLVD
Second Line	:	#126
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-2919
Country	:	US
Telephone Number	:	310-399-4043
Fax Number	:

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

Provider Enumeration Date	:	01/30/2013
Last Update Date	:	01/30/2013

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