=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336594597
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY FYLYPOWYCZ LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2016
-----------------------------------------------------
Last Update Date | 04/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 595 E COLORADO BLVD MEZZANINE SUITE
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-2039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-543-5954
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 595 E COLORADO BLVD MEZZANINE SUITE
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-2039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-543-5954
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 92627
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------