MEDICARE: MR. DAVID FRASER RIPLEY LMFT

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	95937	CA

General Provider Information

NPI Number	:	1245775139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID FRASER RIPLEY LMFT

Provider Business Mailing Address
First Line	:	1990 E VILLA ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-2336
Country	:	US
Telephone Number	:	626-808-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1990 E VILLA ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-2336
Country	:	US
Telephone Number	:	626-808-7200
Fax Number	:

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

Provider Enumeration Date	:	12/30/2016
Last Update Date	:	12/30/2016

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