MEDICARE: PAT T STATEN MFT

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	35167	CA

General Provider Information

NPI Number	:	1265564744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAT T STATEN MFT

Provider Business Mailing Address
First Line	:	1775 E PALM CANYON DR STE 110
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92264-1623
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 N PALM CANYON DR
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-1868
Country	:	US
Telephone Number	:	951-509-2499
Fax Number	:

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

Provider Enumeration Date	:	03/11/2007
Last Update Date	:	03/17/2018

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