MEDICARE: MS. GAIL ST.JAMES 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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1023233848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GAIL ST.JAMES MFTI

Provider Business Mailing Address
First Line	:	932 CANDLEWOOD DR
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-2818
Country	:	US
Telephone Number	:	530-544-3588
Fax Number	:

Provider Business Practice Location Address
First Line	:	932 CANDLEWOOD DR
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-2818
Country	:	US
Telephone Number	:	530-544-3588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/08/2007

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