MEDICARE: DEBRA LYNN POULALION M.F.T.

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	MFC34191	CA

General Provider Information

NPI Number	:	1952427213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA LYNN POULALION M.F.T.

Provider Business Mailing Address
First Line	:	405 W 5TH ST
Second Line	:	SUITE 600
City	:	SANTA ANA
State	:	CA
Zip	:	92701-4519
Country	:	US
Telephone Number	:	714-381-8917
Fax Number	:

Provider Business Practice Location Address
First Line	:	18811 HUNTINGTON ST
Second Line	:	SUITE 200
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-6002
Country	:	US
Telephone Number	:	714-381-8917
Fax Number	:

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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