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NPI Code Detail

MEDICARE: KONIKA ROSENBAUM MCPHERSON MFTI

MEDICARE: KONIKA ROSENBAUM MCPHERSON MFTI
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
1101YM0800XMental Health Counselor
2106H00000XMarriage & Family Therapist65416CA
3106H00000XMarriage & Family Therapist113017CA

General Provider Information

NPI Number : 1003980251
Entity Type Code : Individual
Provider Name (Legal Business Name) : KONIKA ROSENBAUM MCPHERSON MFTI
Provider Business Mailing Address
First Line : 550 N CENTRAL EXPY UNIT 1685
Second Line :
City : MCKINNEY
State : TX
Zip : 75070-0078
Country : US
Telephone Number : 817-841-9411
Fax Number :
Provider Business Practice Location Address
First Line : 2180 JOHNSON AVE
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-4558
Country : US
Telephone Number : 805-781-4865
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2006
Last Update Date : 08/28/2024

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