MEDICARE: MS. LORRAINE NIX LAWRENCE MFT

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	MFT 30684	CA

General Provider Information

NPI Number	:	1164462271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORRAINE NIX LAWRENCE MFT

Provider Business Mailing Address
First Line	:	4145 DEL MAR TRL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2218
Country	:	US
Telephone Number	:	858-794-7809
Fax Number	:	858-794-7809

Provider Business Practice Location Address
First Line	:	4145 DEL MAR TRL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2218
Country	:	US
Telephone Number	:	858-794-7809
Fax Number	:	858-794-7809

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	08/06/2024

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