Provider Demographics
NPI:1639594260
Name:EPTING, MARK RICHARD (MSW, LCSW #80432)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:RICHARD
Last Name:EPTING
Suffix:
Gender:M
Credentials:MSW, LCSW #80432
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 641954
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-6954
Mailing Address - Country:US
Mailing Address - Phone:310-923-8497
Mailing Address - Fax:
Practice Address - Street 1:12401 WILSHIRE BLVD STE 303
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1087
Practice Address - Country:US
Practice Address - Phone:310-923-8497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health