MEDICARE: MS. JULIE ANN KLINGEL 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	MFC 40172	CA

General Provider Information

NPI Number	:	1952518474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE ANN KLINGEL MFT

Provider Business Mailing Address
First Line	:	1039 N HARPER AVE
Second Line	:	APT. #7
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5930
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2107 WILSHIRE BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5735
Country	:	US
Telephone Number	:	310-428-5414
Fax Number	:

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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