MEDICARE: DEX DARE AMFT/APCC

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	158299	CA

General Provider Information

NPI Number	:	1649119744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEX DARE AMFT/APCC

Provider Business Mailing Address
First Line	:	PO BOX 17
Second Line	:
City	:	CLAYTON
State	:	CA
Zip	:	94517-0017
Country	:	US
Telephone Number	:	925-360-9962
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 EBERHARDT CT
Second Line	:
City	:	CLAYTON
State	:	CA
Zip	:	94517-1632
Country	:	US
Telephone Number	:	925-360-9962
Fax Number	:

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

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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