MEDICARE: JAI FLICKER

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	101YS0200X	School Counselor

General Provider Information

NPI Number	:	1255874483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAI FLICKER

Provider Business Mailing Address
First Line	:	55 W BLITHEDALE AVE
Second Line	:
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-1183
Country	:	US
Telephone Number	:	415-888-8411
Fax Number	:

Provider Business Practice Location Address
First Line	:	554 MILLER AVE
Second Line	:	SUITE 3
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-5815
Country	:	US
Telephone Number	:	415-383-4412
Fax Number	:

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

Provider Enumeration Date	:	11/20/2016
Last Update Date	:	11/20/2016

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Directions to “ JAI FLICKER ” Practice Location

Language	Start Address	Practice Location

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