MEDICARE: MS. EDEN MARIE BYRNE MA, 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	48817	CA

General Provider Information

NPI Number	:	1245418060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EDEN MARIE BYRNE MA, LMFT

Provider Business Mailing Address
First Line	:	PO BOX 32
Second Line	:
City	:	MOORPARK
State	:	CA
Zip	:	93020-0032
Country	:	US
Telephone Number	:	805-419-3158
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 E DAILY DR STE 210
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-5839
Country	:	US
Telephone Number	:	805-419-3158
Fax Number	:

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

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	08/14/2020

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