MEDICARE: MS. CATHLEEN LYONS 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	101YM0800X	Mental Health Counselor	MFT29134	CA

General Provider Information

NPI Number	:	1619326626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CATHLEEN LYONS MFT

Provider Business Mailing Address
First Line	:	17000 VENTURA BLVD STE 317
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-4164
Country	:	US
Telephone Number	:	818-990-1989
Fax Number	:

Provider Business Practice Location Address
First Line	:	17000 VENTURA BLVD STE 317
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-4164
Country	:	US
Telephone Number	:	818-990-1989
Fax Number	:

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

Provider Enumeration Date	:	06/09/2016
Last Update Date	:	06/09/2016

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