MEDICARE: KELLY CURRIER

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	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1235518721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY CURRIER

Provider Business Mailing Address
First Line	:	3434 MENDOCINO AVE
Second Line	:	SUITE A, BUILDING C
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2274
Country	:	US
Telephone Number	:	415-322-0938
Fax Number	:

Provider Business Practice Location Address
First Line	:	3434 MENDOCINO AVE
Second Line	:	SUITE A, BUILDING C
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2274
Country	:	US
Telephone Number	:	415-322-0938
Fax Number	:

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

Provider Enumeration Date	:	05/29/2015
Last Update Date	:	02/26/2016

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Directions to “ KELLY CURRIER ” Practice Location

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