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827 4th St Apt 408 Santa Monica CA 90403-1277 | |
| (424) 291-1249 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 827 4th St Apt 408, Santa Monica, California |
| Authorized Official Name and Position | Amanda Marie Espy (PRESIDENT) |
| Authorized Official Contact | 4242911249 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
827 4th St Apt 408 Santa Monica CA 90403-1277 Ph: (424) 291-1249 | 827 4th St Apt 408 Santa Monica CA 90403-1277 Ph: (424) 291-1249 |
| NPI Number | 1982310470 |
|---|---|
| Provider Enumeration Date | 01/27/2023 |
| Last Update Date | 08/04/2024 |
| Certification Date | 08/04/2024 |
| Medicare PECOS PAC ID | 9638619976 |
|---|---|
| Medicare Enrollment ID | O20240912002916 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982310470 | NPI | - | NPPES |
| 1760950109 | Other | CA | NPI |
| 1760950109 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Amanda Marie Espy |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1760950109 PECOS PAC ID: 1658811997 Enrollment ID: I20240918004653 |
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