MEDICARE: MS. LINDA CARLSON 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	MFC 35962	CA

General Provider Information

NPI Number	:	1336292531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA CARLSON MFT

Provider Business Mailing Address
First Line	:	319 E PALM DR
Second Line	:	SUITE C
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3238
Country	:	US
Telephone Number	:	714-307-4656
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 E PALM DR
Second Line	:	SUITE C
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3238
Country	:	US
Telephone Number	:	714-307-4656
Fax Number	:

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	10/26/2012

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