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NPI Code Detail

MEDICARE: MR. LONNIE O WOODLEY MA, MS, LMFT, LEP, P

MEDICARE: MR. LONNIE O WOODLEY MA, MS, LMFT, LEP, P
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 Therapist89707CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1#95-2633765OTHERCAMEDI-CAL

General Provider Information

NPI Number : 1073888277
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LONNIE O WOODLEY MA, MS, LMFT, LEP, P
Provider Business Mailing Address
First Line : 920 E BROADWAY
Second Line :
City : GLENDALE
State : CA
Zip : 91205-1204
Country : US
Telephone Number : 818-242-8403
Fax Number : 818-242-3187
Provider Business Practice Location Address
First Line : 920 E BROADWAY
Second Line :
City : GLENDALE
State : CA
Zip : 91205-1204
Country : US
Telephone Number : 818-242-8403
Fax Number : 818-242-3187
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2012
Last Update Date : 11/21/2016

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