MEDICARE: MISS NISHANA R CLARKE M.S., 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	MFC 47887	CA

General Provider Information

NPI Number	:	1588850630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NISHANA R CLARKE M.S., MFT

Provider Business Mailing Address
First Line	:	PO BOX 696
Second Line	:
City	:	SUN CITY
State	:	CA
Zip	:	92586-0696
Country	:	US
Telephone Number	:	951-378-5233
Fax Number	:	951-800-8164

Provider Business Practice Location Address
First Line	:	29995 TECHNOLOGY DR STE 103
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92563-2633
Country	:	US
Telephone Number	:	951-252-6083
Fax Number	:	951-800-8164

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

Provider Enumeration Date	:	09/22/2007
Last Update Date	:	02/27/2024

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