MEDICARE: MRS. LINDA ANNE FASAN 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	MFC39937	CA

General Provider Information

NPI Number	:	1518018068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA ANNE FASAN MFT

Provider Business Mailing Address
First Line	:	14326 CHANDLER BLVD APT 3
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-5500
Country	:	US
Telephone Number	:	818-231-7175
Fax Number	:	818-981-0583

Provider Business Practice Location Address
First Line	:	14156 MAGNOLIA BLVD STE 105
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-6410
Country	:	US
Telephone Number	:	818-231-7175
Fax Number	:	818-981-0583

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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