MEDICARE: JUDITH RINDA CRANE LMFT, LPCC

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	101YP2500X	Professional Counselor	LPCC 1467	CA
2	106H00000X	Marriage & Family Therapist	43387	CA

General Provider Information

NPI Number	:	1982089959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH RINDA CRANE LMFT, LPCC

Provider Business Mailing Address
First Line	:	2959 S SEPULVEDA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3912
Country	:	US
Telephone Number	:	310-205-8483
Fax Number	:

Provider Business Practice Location Address
First Line	:	2959 S SEPULVEDA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3912
Country	:	US
Telephone Number	:	310-205-8483
Fax Number	:

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

Provider Enumeration Date	:	07/20/2015
Last Update Date	:	07/20/2015

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