MEDICARE: SUZANNE LIE MFCC

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	MFC22674	CA

General Provider Information

NPI Number	:	1689859571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE LIE MFCC

Provider Business Mailing Address
First Line	:	521 SAPPHIRE ST
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-4257
Country	:	US
Telephone Number	:	310-540-1313
Fax Number	:	310-540-1322

Provider Business Practice Location Address
First Line	:	521 SAPPHIRE ST
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-4257
Country	:	US
Telephone Number	:	310-540-1313
Fax Number	:	310-540-1322

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

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	01/09/2008

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