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NPI Code Detail

MEDICARE: MRS. DENA MARIE LANDRUM M.F.T.

MEDICARE:  MRS. DENA MARIE LANDRUM  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 Therapist38337CA

General Provider Information

NPI Number : 1063624450
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DENA MARIE LANDRUM M.F.T.
Provider Business Mailing Address
First Line : 2400 LAS GALLINAS AVE
Second Line : SUITE 160
City : SAN RAFAEL
State : CA
Zip : 94903-1447
Country : US
Telephone Number : 415-491-0205
Fax Number :
Provider Business Practice Location Address
First Line : 2400 LAS GALLINAS AVE
Second Line : SUITE 160
City : SAN RAFAEL
State : CA
Zip : 94903-1447
Country : US
Telephone Number : 415-491-0205
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. DENA MARIE LANDRUM M.F.T.” Practice Location

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