MEDICARE: SONOMA COUNTY 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	261QM0855X	Adolescent and Children Mental Health Clinic/Center	LMFT34259	CA

General Provider Information

NPI Number	:	1245604909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONOMA COUNTY COUNSELING

Provider Business Mailing Address
First Line	:	PO BOX 9591
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-1591
Country	:	US
Telephone Number	:	707-322-1929
Fax Number	:	707-540-0484

Provider Business Practice Location Address
First Line	:	3434 MENDOCINO AVE
Second Line	:	BUILDING C
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2274
Country	:	US
Telephone Number	:	707-322-1929
Fax Number	:	707-540-0484

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MR. PAUL E MARGOLIS
Credential	:	LMFT
Telephone Number	:	707-322-1929

Provider Enumeration Date	:	11/18/2015
Last Update Date	:	11/18/2015

Similar Medicare Providers

1689997637 — MR. PAUL E. MARGOLIS LMFT
Practice Location Address:

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Practice Location Address:

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1275193674 — MARIE NERSESIAN MA
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Directions to “SONOMA COUNTY COUNSELING ” Practice Location

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