MEDICARE: JOY LICON

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	151411	CA

General Provider Information

NPI Number	:	1821801275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY LICON

Provider Business Mailing Address
First Line	:	545 N RIMSDALE AVE UNIT 2883
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91722-7185
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 SANTA ANITA AVE
Second Line	:
City	:	SOUTH EL MONTE
State	:	CA
Zip	:	91733-3311
Country	:	US
Telephone Number	:	626-575-5425
Fax Number	:

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

Provider Enumeration Date	:	01/29/2025
Last Update Date	:	01/29/2025

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Directions to “ JOY LICON ” Practice Location

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