MEDICARE: SUZANNA GEE MFT

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	99314	CA

General Provider Information

NPI Number	:	1144600941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNA GEE MFT

Provider Business Mailing Address
First Line	:	2655 PORTAGE BAY E STE 5
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-3073
Country	:	US
Telephone Number	:	916-550-3376
Fax Number	:

Provider Business Practice Location Address
First Line	:	2655 PORTAGE BAY E STE 5
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-3073
Country	:	US
Telephone Number	:	916-550-3376
Fax Number	:

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

Provider Enumeration Date	:	06/05/2015
Last Update Date	:	03/17/2018

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