MEDICARE: MR. JAMES ANDREW 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	MFC43813	CA

General Provider Information

NPI Number	:	1366563918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES ANDREW CARLSON MFT

Provider Business Mailing Address
First Line	:	PO BOX 4323
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93140-4323
Country	:	US
Telephone Number	:	888-202-8477
Fax Number	:	805-682-0484

Provider Business Practice Location Address
First Line	:	1815 STATE ST
Second Line	:	SUITE E
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-8404
Country	:	US
Telephone Number	:	888-202-8477
Fax Number	:	805-682-0484

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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