MEDICARE: MS. CAROLE ANN KRIES L.M.F.T.

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	MFC32624	CA

General Provider Information

NPI Number	:	1790016251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLE ANN KRIES L.M.F.T.

Provider Business Mailing Address
First Line	:	2725 CONGRESS ST
Second Line	:	SUITE 2C
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-2757
Country	:	US
Telephone Number	:	619-977-3439
Fax Number	:	619-688-1098

Provider Business Practice Location Address
First Line	:	2725 CONGRESS ST
Second Line	:	SUITE 2C
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-2757
Country	:	US
Telephone Number	:	619-977-3439
Fax Number	:	619-688-1098

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

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	01/22/2010

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