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NPI Code Detail

MEDICARE: MS. MACIA L. COULTER

MEDICARE: MS. MACIA L. COULTER
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1548454234
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MACIA L. COULTER
Provider Business Mailing Address
First Line : 1225 LEWIS RD
Second Line :
City : ROYAL OAKS
State : CA
Zip : 95076-9313
Country : US
Telephone Number : 831-394-4622
Fax Number : 831-394-1930
Provider Business Practice Location Address
First Line : 1178 BROADWAY AVE
Second Line :
City : SEASIDE
State : CA
Zip : 93955-4934
Country : US
Telephone Number : 831-394-4622
Fax Number : 831-394-1930
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2007
Last Update Date : 09/05/2007

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