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NPI Code Detail

MEDICARE: MS. LANITA DYER LMFT

MEDICARE: MS. LANITA DYER 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
1101YA0400XAddiction (Substance Use Disorder) CounselorIMF 57847CA
2106H00000XMarriage & Family TherapistLMFT 82475CA

General Provider Information

NPI Number : 1578694014
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LANITA DYER LMFT
Provider Business Mailing Address
First Line : PO BOX 656
Second Line :
City : GARDENA
State : CA
Zip : 90248-0656
Country : US
Telephone Number : 310-686-1139
Fax Number :
Provider Business Practice Location Address
First Line : 15519 CRENSHAW BLVD
Second Line :
City : GARDENA
State : CA
Zip : 90249-4597
Country : US
Telephone Number : 310-679-9126
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 12/03/2020

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