MEDICARE: MARY L. FAIRLEY-SLOCUM

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	49512	CA

General Provider Information

NPI Number	:	1922274513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY L. FAIRLEY-SLOCUM

Provider Business Mailing Address
First Line	:	7806 UPLANDS WAY STE A
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7567
Country	:	US
Telephone Number	:	916-967-6253
Fax Number	:	916-967-9413

Provider Business Practice Location Address
First Line	:	7806 UPLANDS WAY STE A
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7567
Country	:	US
Telephone Number	:	916-967-6253
Fax Number	:	916-967-9413

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

Provider Enumeration Date	:	05/02/2008
Last Update Date	:	05/02/2008

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