Organization
MIRACLE MILE COMMUNITY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID MARSTEN LCSW (DIRECTOR)
(323) 936-3965
Entity
Organization
Contact information
Practice address
7461 BEVERLY BLVD STE 405, LOS ANGELES, CA 90036-2774
(323) 939-6355
Mailing address
7461 BEVERLY BLVD STE 405, LOS ANGELES, CA 90036-2774
(323) 939-6355
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
52614
CA
251S00000X
Community/Behavioral Health Agency
Primary
LCS15899
CA
Other
Enumeration date
06/07/2015
Last updated
06/07/2015
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