MEDICARE: MR. RUSSELL ERIC HENDLIN MA, 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	MFC 25562	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01CR	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1386843688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RUSSELL ERIC HENDLIN MA, LMFT

Provider Business Mailing Address
First Line	:	PO BOX 189
Second Line	:
City	:	SAN GERONIMO
State	:	CA
Zip	:	94963-0189
Country	:	US
Telephone Number	:	415-233-0788
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 RED HILL AVE STE 17
Second Line	:
City	:	SAN ANSELMO
State	:	CA
Zip	:	94960-2443
Country	:	US
Telephone Number	:	415-233-0788
Fax Number	:

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

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	09/10/2025

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