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NPI 1215177381

NPI 1215177381 : RUSSELL HOWARD SEMPELL MFT : BAKERSFIELD, CA

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General NPI Number Information
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    NPI Number           |    1215177381
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    Entity Type          |    Individual 
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    Provider Name        |    RUSSELL HOWARD SEMPELL MFT
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    03/02/2009
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    Last Update Date     |    03/02/2009
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Provider Practice Location Address
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    Address Line         |    1408 CORTE CANALETTE 
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    City                 |    BAKERSFIELD
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    State                |    CA
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    Zip                  |    93309-7128
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    Country              |    US
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    Telephone            |    661-831-4706
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    PO BOX 10296 
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    City                 |    BAKERSFIELD
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    State                |    CA
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    Zip                  |    93389-0296
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    Country              |    US
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    Telephone            |    661-831-4706
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    Fax                  |    
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    106H00000X
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    Taxonomy Name        |    Marriage & Family Therapist
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    License Number       |    MFC21849
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    License Number State |    CA
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