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NPI Code Detail

MEDICARE: MS. LAURA SOBLE MFT

MEDICARE: MS. LAURA SOBLE 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
1106H00000XMarriage & Family TherapistMFC31926CA

General Provider Information

NPI Number : 1396879276
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LAURA SOBLE MFT
Provider Business Mailing Address
First Line : PO BOX 135
Second Line :
City : FAIRFAX
State : CA
Zip : 94978
Country : US
Telephone Number : 510-527-1501
Fax Number : 510-531-1134
Provider Business Practice Location Address
First Line : 15 AUSTIN AVE
Second Line :
City : SAN ANSELMO
State : CA
Zip : 94960-2924
Country : US
Telephone Number : 510-527-1501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 03/24/2022

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