MEDICARE: MRS. NADINE - BECKER M.A.

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	MFT16766	CA

General Provider Information

NPI Number	:	1073689972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NADINE - BECKER M.A.

Provider Business Mailing Address
First Line	:	6345 BALBOA BLVD
Second Line	:	SUITE 212
City	:	ENCINO
State	:	CA
Zip	:	91316-1519
Country	:	US
Telephone Number	:	818-343-8686
Fax Number	:	818-776-0312

Provider Business Practice Location Address
First Line	:	6345 BALBOA BLVD
Second Line	:	SUITE 212
City	:	ENCINO
State	:	CA
Zip	:	91316-1519
Country	:	US
Telephone Number	:	818-343-8686
Fax Number	:	818-776-0312

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

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	07/08/2007

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