MEDICARE: RICHARD WAYNE 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	MFC48247	CA

General Provider Information

NPI Number	:	1538504295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD WAYNE LMFT

Provider Business Mailing Address
First Line	:	23441 S POINTE DR STE 200
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1552
Country	:	US
Telephone Number	:	949-294-6700
Fax Number	:	949-454-2610

Provider Business Practice Location Address
First Line	:	23441 S POINTE DR STE 200
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1552
Country	:	US
Telephone Number	:	949-294-6700
Fax Number	:	949-454-2610

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

Provider Enumeration Date	:	05/07/2013
Last Update Date	:	05/07/2013

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