MEDICARE: TURLOCK FAMILY COUNSELING

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

General Provider Information

NPI Number	:	1235748872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TURLOCK FAMILY COUNSELING

Provider Business Mailing Address
First Line	:	PO BOX 139
Second Line	:
City	:	DENAIR
State	:	CA
Zip	:	95316-0139
Country	:	US
Telephone Number	:	209-850-0844
Fax Number	:

Provider Business Practice Location Address
First Line	:	261 N PALM ST
Second Line	:
City	:	TURLOCK
State	:	CA
Zip	:	95380-4028
Country	:	US
Telephone Number	:	209-850-0844
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMY KIRSTEN MUNDELLO
Credential	:	LMFT
Telephone Number	:	209-850-0844

Provider Enumeration Date	:	07/29/2020
Last Update Date	:	07/29/2020

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Directions to “TURLOCK FAMILY COUNSELING ” Practice Location

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