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NPI Code Detail

MEDICARE: JEFFERY S PARK LMFT 108456

MEDICARE: JEFFERY S PARK LMFT 108456
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
1106H00000XMarriage & Family TherapistIMF79146CA
2106H00000XMarriage & Family Therapist108456
3106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1922424274
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFERY S PARK LMFT 108456
Provider Business Mailing Address
First Line : 4010 SAWTELLE BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90066-5408
Country : US
Telephone Number : 213-290-3870
Fax Number :
Provider Business Practice Location Address
First Line : 4010 SAWTELLE BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90066-5408
Country : US
Telephone Number : 213-290-3870
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2014
Last Update Date : 10/24/2022

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Directions to “ JEFFERY S PARK LMFT 108456” Practice Location

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