MEDICARE: LILLIAN VICTORIA STROM LMFT

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	115346	CA

General Provider Information

NPI Number	:	1114578697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN VICTORIA STROM LMFT

Provider Business Mailing Address
First Line	:	PO BOX 3432
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92605-3432
Country	:	US
Telephone Number	:	714-794-2269
Fax Number	:

Provider Business Practice Location Address
First Line	:	5020 CAMPUS DR
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2120
Country	:	US
Telephone Number	:	714-794-2260
Fax Number	:

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

Provider Enumeration Date	:	09/25/2019
Last Update Date	:	09/25/2019

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