MEDICARE: TSEGAMLAK TELEALE WORKU 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	MFC 37565	CA

General Provider Information

NPI Number	:	1922165802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TSEGAMLAK TELEALE WORKU M.F.T.

Provider Business Mailing Address
First Line	:	1000 E WALNUT ST
Second Line	:	SUITE 115
City	:	PASADENA
State	:	CA
Zip	:	91106-1452
Country	:	US
Telephone Number	:	626-786-1019
Fax Number	:	626-628-3638

Provider Business Practice Location Address
First Line	:	1000 E WALNUT ST
Second Line	:	SUITE 115
City	:	PASADENA
State	:	CA
Zip	:	91106-1452
Country	:	US
Telephone Number	:	626-786-1019
Fax Number	:	626-628-3638

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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