MEDICARE: LYNNEA AEILINE AVENETTI M.A.

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	101YM0800X	Mental Health Counselor	C4202	OR

General Provider Information

NPI Number	:	1306163035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNNEA AEILINE AVENETTI M.A.

Provider Business Mailing Address
First Line	:	3077 NE MADISON AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6550
Country	:	US
Telephone Number	:	541-848-7368
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 SW EMKAY DR STE 104
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97702-3162
Country	:	US
Telephone Number	:	541-323-3477
Fax Number	:

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

Provider Enumeration Date	:	04/20/2010
Last Update Date	:	02/15/2024

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