MEDICARE: LYNN LONDON 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
1	106H00000X	Marriage & Family Therapist	MFT37959	CA

General Provider Information

NPI Number	:	1437225448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN LONDON MFT

Provider Business Mailing Address
First Line	:	322 19TH ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90402-2410
Country	:	US
Telephone Number	:	310-395-3474
Fax Number	:

Provider Business Practice Location Address
First Line	:	12011 SAN VICENTE BLVD
Second Line	:	#402
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-4926
Country	:	US
Telephone Number	:	310-395-6390
Fax Number	:

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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