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NPI Code Detail

MEDICARE: MS. NICOLE SUMMER MCCUISTION MFT

MEDICARE: MS. NICOLE SUMMER MCCUISTION 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
1106H00000XMarriage & Family TherapistMFC42478CA

General Provider Information

NPI Number : 1790794105
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NICOLE SUMMER MCCUISTION MFT
Provider Business Mailing Address
First Line : 131 W MIDWAY DR
Second Line :
City : ANAHEIM
State : CA
Zip : 92805-6507
Country : US
Telephone Number : 714-717-3711
Fax Number :
Provider Business Practice Location Address
First Line : 131 W MIDWAY DR
Second Line :
City : ANAHEIM
State : CA
Zip : 92805-6507
Country : US
Telephone Number : 714-517-7107
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2006
Last Update Date : 11/23/2010

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