MEDICARE: MS. LYNNE MARION DIXON MFT

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	22153	CA

General Provider Information

NPI Number	:	1487866869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYNNE MARION DIXON MFT

Provider Business Mailing Address
First Line	:	1939 DIVISADERO ST
Second Line	:	SUITE 1
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2507
Country	:	US
Telephone Number	:	415-346-4876
Fax Number	:	415-507-9045

Provider Business Practice Location Address
First Line	:	1939 DIVISADERO ST
Second Line	:	SUITE 1
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2507
Country	:	US
Telephone Number	:	415-346-4876
Fax Number	:	415-507-9045

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

Provider Enumeration Date	:	05/05/2007
Last Update Date	:	07/08/2007

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