MEDICARE: MRS. NANCY A WHITE 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	MFC40492	CA

General Provider Information

NPI Number	:	1437309796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY A WHITE LMFT

Provider Business Mailing Address
First Line	:	13193 CENTRAL AVE
Second Line	:	SUITE 200
City	:	CHINO
State	:	CA
Zip	:	91710-4179
Country	:	US
Telephone Number	:	909-902-9111
Fax Number	:	909-902-9199

Provider Business Practice Location Address
First Line	:	13193 CENTRAL AVE
Second Line	:	SUITE 200
City	:	CHINO
State	:	CA
Zip	:	91710-4179
Country	:	US
Telephone Number	:	909-902-9111
Fax Number	:	909-902-9199

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

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	09/23/2008

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