MEDICARE: GINA ELIZABETH TAMPLIN 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	112007	CA

General Provider Information

NPI Number	:	1184253908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA ELIZABETH TAMPLIN LMFT

Provider Business Mailing Address
First Line	:	720 N CATALINA ST
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-3017
Country	:	US
Telephone Number	:	602-405-3142
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 S LAMAR BLVD APT 1413
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-0198
Country	:	US
Telephone Number	:	323-577-9581
Fax Number	:

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

Provider Enumeration Date	:	04/03/2020
Last Update Date	:	04/03/2020

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