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General NPI Number Information
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NPI Number | 1700900024
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Entity Type | Individual
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Provider Name | HOLLY LYNN PEDERSEN MFT, PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3737 MARTIN LUTHER KING JR BLVD STE 612
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City | LYNWOOD
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State | CA
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Zip | 90262-3537
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Country | US
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Telephone | 310-603-2795
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Fax | 310-928-0368
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Provider Business Mailing Address
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Address Line | 4226 LINDEN AVE
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City | LONG BEACH
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State | CA
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Zip | 90807-2723
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Country | US
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Telephone | 323-719-0959
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Fax | 310-928-0368
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC37441
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License Number State | CA
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