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NPI Code Detail

MEDICARE: MISS ELAINE GRACE MCMAHON M.F.T.

MEDICARE: MISS ELAINE GRACE MCMAHON M.F.T.
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
1106H00000XMarriage & Family TherapistMFT37791CA

General Provider Information

NPI Number : 1003913393
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS ELAINE GRACE MCMAHON M.F.T.
Provider Business Mailing Address
First Line : PO BOX 1084
Second Line :
City : MILL VALLEY
State : CA
Zip : 94942-1084
Country : US
Telephone Number : 415-299-2376
Fax Number :
Provider Business Practice Location Address
First Line : 15 AUSTIN AVE
Second Line :
City : SAN ANSELMO
State : CA
Zip : 94960-2924
Country : US
Telephone Number : 415-299-2376
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 03/18/2022

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