MEDICARE: NICOLE LAWRENCE M.A. M.F.T

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	101YM0800X	Mental Health Counselor	44747	CA
2	106H00000X	Marriage & Family Therapist	44747	CA

General Provider Information

NPI Number	:	1134319742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE LAWRENCE M.A. M.F.T

Provider Business Mailing Address
First Line	:	369 S DOHENY DR
Second Line	:	SUITE 1421
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3508
Country	:	US
Telephone Number	:	310-203-1399
Fax Number	:

Provider Business Practice Location Address
First Line	:	9107 WILSHIRE BLVD
Second Line	:	SUITE 200
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5508
Country	:	US
Telephone Number	:	310-203-1399
Fax Number	:

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

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	08/08/2007

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