MEDICARE: MR. LARRY S HYMES MFC

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	MFC478870	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205141405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY S HYMES MFC

Provider Business Mailing Address
First Line	:	8235 SANTA MONICA BLVD STE 311
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5969
Country	:	US
Telephone Number	:	323-896-0635
Fax Number	:

Provider Business Practice Location Address
First Line	:	8235 SANTA MONICA BLVD STE 311
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5969
Country	:	US
Telephone Number	:	323-896-0635
Fax Number	:

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

Provider Enumeration Date	:	08/11/2010
Last Update Date	:	10/25/2019

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