MEDICARE: MR. RANDALL LEIGH JOST 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	MFC25601	CA

General Provider Information

NPI Number	:	1124186184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RANDALL LEIGH JOST LMFT

Provider Business Mailing Address
First Line	:	1106 E GRAND AVE STE B
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-2516
Country	:	US
Telephone Number	:	805-473-7060
Fax Number	:

Provider Business Practice Location Address
First Line	:	1106 E GRAND AVE
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-2516
Country	:	US
Telephone Number	:	805-473-7060
Fax Number	:	805-473-7124

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/16/2007

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