MEDICARE: CONNIE K STRAHAN PSY.D.

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	103TC0700X	Clinical Psychologist	PSY 21729	CA

General Provider Information

NPI Number	:	1881849867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE K STRAHAN PSY.D.

Provider Business Mailing Address
First Line	:	1949 1/2 WESTWOOD BLVD
Second Line	:	SUITE 7
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-8414
Country	:	US
Telephone Number	:	310-936-1184
Fax Number	:	310-478-1184

Provider Business Practice Location Address
First Line	:	1949 1/2 WESTWOOD BLVD
Second Line	:	SUITE 7
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-8414
Country	:	US
Telephone Number	:	310-936-1184
Fax Number	:	310-478-1184

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

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	11/18/2008

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