MEDICARE: MRS. BARBARA BENOUALID JD., 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	51443	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D5861729	OTHER		DRIVERS LICENSE

General Provider Information

NPI Number	:	1922632439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BARBARA BENOUALID JD., LMFT

Provider Business Mailing Address
First Line	:	5421 LOUISE AVE
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-2540
Country	:	US
Telephone Number	:	323-445-0962
Fax Number	:

Provider Business Practice Location Address
First Line	:	3255 CAHUENGA BLVD W
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90068-1375
Country	:	US
Telephone Number	:	323-327-3399
Fax Number	:

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

Provider Enumeration Date	:	02/24/2020
Last Update Date	:	02/24/2020

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