MEDICARE: ANAIS LYN PLASKETES MA, 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	100410	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100410	OTHER	CA	LICENSED MARRIAGE AND FAMILY THERAPIST

General Provider Information

NPI Number	:	1922519578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANAIS LYN PLASKETES MA, LMFT

Provider Business Mailing Address
First Line	:	444 N LARCHMONT BLVD STE 109
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 N LARCHMONT BLVD STE 109
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3030
Country	:	US
Telephone Number	:	323-544-3972
Fax Number	:

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

Provider Enumeration Date	:	10/21/2017
Last Update Date	:	10/21/2017

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