MEDICARE: LINEAGE & LEGACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP2500X	Professional Counselor
3	174H00000X	Health Educator
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1295410967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINEAGE & LEGACY

Provider Business Mailing Address
First Line	:	PO BOX 51298
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94303-0697
Country	:	US
Telephone Number	:	408-661-5795
Fax Number	:	408-608-3347

Provider Business Practice Location Address
First Line	:	2512 FARRINGTON WAY
Second Line	:
City	:	EAST PALO ALTO
State	:	CA
Zip	:	94303-1118
Country	:	US
Telephone Number	:	408-661-5795
Fax Number	:	408-608-3347

Authorized Official
Title or Position	:	CONFIDANTE
Name	:	TAMARA SMITH-JONES
Credential	:	CPSS
Telephone Number	:	408-661-5795

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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Directions to “LINEAGE & LEGACY ” Practice Location

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