MEDICARE: LINDA GOODWIN SNOUFFER LCSW, CEAP

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	LCS23244	CA

General Provider Information

NPI Number	:	1568473338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA GOODWIN SNOUFFER LCSW, CEAP

Provider Business Mailing Address
First Line	:	PO BOX 2664
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-1764
Country	:	US
Telephone Number	:	310-266-4063
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 OCEAN PARK BLVD
Second Line	:	SUITE 120
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-3224
Country	:	US
Telephone Number	:	310-266-4063
Fax Number	:

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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