=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316154495
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN ELAINE FURMAN MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 819 15TH ST
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95354-1113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-571-6054
-----------------------------------------------------
Fax | 209-522-5700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2832 FINLANDIA AVE
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95358-1222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-525-8880
-----------------------------------------------------
Fax | 209-522-5700
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC27806
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------