MEDICARE: MR. CARL C FERIL JR. LCMFT

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	665	KS

General Provider Information

NPI Number	:	1124268115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARL C FERIL JR. LCMFT

Provider Business Mailing Address
First Line	:	608 N EXCHANGE ST
Second Line	:
City	:	SAINT JOHN
State	:	KS
Zip	:	67576-1627
Country	:	US
Telephone Number	:	620-546-3807
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 N EXCHANGE ST
Second Line	:
City	:	SAINT JOHN
State	:	KS
Zip	:	67576-1627
Country	:	US
Telephone Number	:	620-546-3807
Fax Number	:

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

Provider Enumeration Date	:	03/03/2009
Last Update Date	:	03/03/2009

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