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NPI Code Detail

MEDICARE: TRACY LAN CHINN MFT

MEDICARE: TRACY LAN CHINN 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
1106H00000XMarriage & Family Therapist41376CA

General Provider Information

NPI Number : 1093846594
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY LAN CHINN MFT
Provider Business Mailing Address
First Line : PO BOX 802316
Second Line :
City : SANTA CLARITA
State : CA
Zip : 91380-2316
Country : US
Telephone Number : 310-213-6430
Fax Number :
Provider Business Practice Location Address
First Line : 601 S GLENOAKS BLVD STE 200
Second Line :
City : BURBANK
State : CA
Zip : 91502-2787
Country : US
Telephone Number : 310-213-6430
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 07/08/2007

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Directions to “ TRACY LAN CHINN MFT” Practice Location

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