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NPI Code Detail

MEDICARE: MISS MIA LYNETTE WILLIAMS

MEDICARE: MISS MIA LYNETTE WILLIAMS
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
1106H00000XMarriage & Family Therapist91018CA
2225400000XRehabilitation Practitioner
3106H00000XMarriage & Family Therapist142858CA

General Provider Information

NPI Number : 1023140647
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MIA LYNETTE WILLIAMS
Provider Business Mailing Address
First Line : 2500 E FOOTHILL BLVD STE 300
Second Line :
City : PASADENA
State : CA
Zip : 91107-7102
Country : US
Telephone Number : 626-395-7100
Fax Number :
Provider Business Practice Location Address
First Line : 2500 E FOOTHILL BLVD STE 300
Second Line :
City : PASADENA
State : CA
Zip : 91107-7102
Country : US
Telephone Number : 626-676-0803
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2007
Last Update Date : 06/06/2024

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Directions to “ MISS MIA LYNETTE WILLIAMS ” Practice Location

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