MEDICARE: AMY M PRICE 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	IMF 44255	CA
2	106H00000X	Marriage & Family Therapist	MFC48856	CA

General Provider Information

NPI Number	:	1437328762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY M PRICE MFT

Provider Business Mailing Address
First Line	:	1740 LA COSTA MEADOWS DR
Second Line	:	SUITE 104
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-5199
Country	:	US
Telephone Number	:	760-593-7350
Fax Number	:	760-591-0086

Provider Business Practice Location Address
First Line	:	1740 LA COSTA MEADOWS DR
Second Line	:	SUITE 104
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-5199
Country	:	US
Telephone Number	:	760-593-7350
Fax Number	:	760-591-0086

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

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	01/16/2018

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Directions to “ AMY M PRICE MFT” Practice Location

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