MEDICARE: EVA VAN HORN

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	101YP2500X	Professional Counselor	77818	CA

General Provider Information

NPI Number	:	1053867457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVA VAN HORN

Provider Business Mailing Address
First Line	:	1781 QUESADA AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94124-2336
Country	:	US
Telephone Number	:	209-769-6084
Fax Number	:

Provider Business Practice Location Address
First Line	:	1388 SUTTER ST
Second Line	:	SUITE 412
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-5427
Country	:	US
Telephone Number	:	209-769-6084
Fax Number	:

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

Provider Enumeration Date	:	08/26/2016
Last Update Date	:	08/26/2016

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Directions to “ EVA VAN HORN ” Practice Location

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