MEDICARE: M KIENE LANDRY

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	36709	CA

General Provider Information

NPI Number	:	1831334713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	M KIENE LANDRY

Provider Business Mailing Address
First Line	:	8354 NATALIE LN
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91304-3124
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8354 NATALIE LN
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91304-3124
Country	:	US
Telephone Number	:	818-613-8827
Fax Number	:

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

Provider Enumeration Date	:	12/08/2008
Last Update Date	:	12/08/2008

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Directions to “ M KIENE LANDRY ” Practice Location

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