MEDICARE: MS. PENNY TIMMONS 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	MFC90539	CA

General Provider Information

NPI Number	:	1174079651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PENNY TIMMONS LMFT

Provider Business Mailing Address
First Line	:	721 N EDINBURGH AVE
Second Line	:	APT. 5
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-7018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2717 S ROBERTSON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-2442
Country	:	US
Telephone Number	:	310-560-9456
Fax Number	:

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

Provider Enumeration Date	:	08/25/2016
Last Update Date	:	08/25/2016

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