=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932975448
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDON STEELE LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2023
-----------------------------------------------------
Last Update Date | 11/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 TAMAL PLZ STE 130
-----------------------------------------------------
City | CORTE MADERA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94925-1195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-672-9394
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 380 CHANNING WAY APT 172
-----------------------------------------------------
City | SAN RAFAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94903-2625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-672-9394
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | LMFT140541
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------