Provider Demographics
NPI:1689858375
Name:MORTON, JANIE LYNETTE (CCDC)
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:LYNETTE
Last Name:MORTON
Suffix:
Gender:F
Credentials:CCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11900 SOUTH AVALON BLVD SUITE 200
Mailing Address - Street 2:1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90061
Mailing Address - Country:US
Mailing Address - Phone:323-242-0500
Mailing Address - Fax:323-242-0600
Practice Address - Street 1:11900 AVALON BLVD STE 200
Practice Address - Street 2:1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061-2867
Practice Address - Country:US
Practice Address - Phone:323-242-0500
Practice Address - Fax:323-242-0600
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC101OtherC101