MEDICARE: MRS. BONNIE LEE BAN 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	8951	CA

General Provider Information

NPI Number	:	1922129592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BONNIE LEE BAN LMFT

Provider Business Mailing Address
First Line	:	2530 AMHERST AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2712
Country	:	US
Telephone Number	:	310-335-6926
Fax Number	:	310-694-0084

Provider Business Practice Location Address
First Line	:	2530 AMHERST AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2712
Country	:	US
Telephone Number	:	310-335-6926
Fax Number	:	310-694-0084

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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