MEDICARE: BEHAVIORAL HEALTH FAMILY COUNSELING & EDUCATIONAL CONSULTING, PC

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	MFC31131	CA

General Provider Information

NPI Number	:	1952331134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL HEALTH FAMILY COUNSELING & EDUCATIONAL CONSULTING, PC

Provider Business Mailing Address
First Line	:	3415 BRETON AVE
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-2709
Country	:	US
Telephone Number	:	530-758-1021
Fax Number	:	530-758-1021

Provider Business Practice Location Address
First Line	:	2055 ANDERSON RD
Second Line	:	# 5
City	:	DAVIS
State	:	CA
Zip	:	95616-0672
Country	:	US
Telephone Number	:	530-758-7163
Fax Number	:	530-758-1021

Authorized Official
Title or Position	:	MARRIAGE FAMILY THERAPIST
Name	:	MS. TERI ANNE DRAKE
Credential	:	RN, MFT
Telephone Number	:	530-758-7163

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	08/22/2020

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