MEDICARE: MS. SHANNON M. BYRNES M.A.

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	MFC #44046	CA

General Provider Information

NPI Number	:	1689823825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANNON M. BYRNES M.A.

Provider Business Mailing Address
First Line	:	12304 SANTA MONICA BLVD
Second Line	:	SUITE 300
City	:	W LOS ANGELES
State	:	CA
Zip	:	90025-2551
Country	:	US
Telephone Number	:	310-207-0123
Fax Number	:

Provider Business Practice Location Address
First Line	:	12304 SANTA MONICA BLVD
Second Line	:	SUITE 300
City	:	W LOS ANGELES
State	:	CA
Zip	:	90025-2551
Country	:	US
Telephone Number	:	310-207-0123
Fax Number	:

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

Provider Enumeration Date	:	09/11/2008
Last Update Date	:	09/11/2008

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