MEDICARE: TERRANCE JAMES BROWN 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
1	106H00000X	Marriage & Family Therapist	MFC43093	CA

General Provider Information

NPI Number	:	1982732525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRANCE JAMES BROWN MFT

Provider Business Mailing Address
First Line	:	4137 MOUNT ALIFAN PL UNIT J
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-2809
Country	:	US
Telephone Number	:	858-254-9141
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 EMERALD ST
Second Line	:	SUITE 123
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-2712
Country	:	US
Telephone Number	:	858-569-6284
Fax Number	:

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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