MEDICARE: MS. BRANDI KELFER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	0000000	CA

General Provider Information

NPI Number	:	1043302086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRANDI KELFER

Provider Business Mailing Address
First Line	:	3437 MYRTLE AVE
Second Line	:	#420
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-5145
Country	:	US
Telephone Number	:	916-338-6835
Fax Number	:

Provider Business Practice Location Address
First Line	:	3437 MYRTLE AVE
Second Line	:	#420
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-5145
Country	:	US
Telephone Number	:	916-338-6835
Fax Number	:

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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