MEDICARE: MRS. JUDY ANN WEGNES 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	36980	CA

General Provider Information

NPI Number	:	1700097714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDY ANN WEGNES LMFT

Provider Business Mailing Address
First Line	:	2800 PLAZA DEL AMO UNIT 362
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90503-7399
Country	:	US
Telephone Number	:	310-528-9865
Fax Number	:

Provider Business Practice Location Address
First Line	:	1243 ARTESIA BLVD
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-6970
Country	:	US
Telephone Number	:	310-528-9865
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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