=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427425461
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMQ FAMILIES FIRST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2015
-----------------------------------------------------
Last Update Date | 08/25/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35274 AVENUE 15
-----------------------------------------------------
City | MADERA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93636-8437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-395-4056
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35274 AVENUE 15
-----------------------------------------------------
City | MADERA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93636-8437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-395-4056
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICIAN I
-----------------------------------------------------
Name | VERONICA MILAN
-----------------------------------------------------
Credential | MFTI
-----------------------------------------------------
Telephone | 559-395-4056
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | IMF85205
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------