MEDICARE: LENNA K LEBOVICH MA

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	49650	CA
2	101YM0800X	Mental Health Counselor	1658	CA

General Provider Information

NPI Number	:	1518159243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LENNA K LEBOVICH MA

Provider Business Mailing Address
First Line	:	12012 WILSHIRE BLVD STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1203
Country	:	US
Telephone Number	:	310-205-2646
Fax Number	:

Provider Business Practice Location Address
First Line	:	12012 WILSHIRE BLVD STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1203
Country	:	US
Telephone Number	:	310-205-2646
Fax Number	:

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

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	01/12/2024

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