MEDICARE: MS. JAMIE LAUREN CARRUTH 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	90274	CA

General Provider Information

NPI Number	:	1942719091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAMIE LAUREN CARRUTH LMFT

Provider Business Mailing Address
First Line	:	3361 GLENDALE BLVD FL 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1825
Country	:	US
Telephone Number	:	14242487986
Fax Number	:

Provider Business Practice Location Address
First Line	:	3361 GLENDALE BLVD FL 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1825
Country	:	US
Telephone Number	:	14242487986
Fax Number	:

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

Provider Enumeration Date	:	09/20/2017
Last Update Date	:	09/20/2017

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