MEDICARE: FORD T MONELL MFT

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	106H00000X	Marriage & Family Therapist	MFC41277	CA

General Provider Information

NPI Number	:	1083633259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FORD T MONELL MFT

Provider Business Mailing Address
First Line	:	3536 LIME AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-4640
Country	:	US
Telephone Number	:	562-307-2743
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S KRAEMER BLVD
Second Line	:	STE. 110
City	:	PLACENTIA
State	:	CA
Zip	:	92870-6105
Country	:	US
Telephone Number	:	562-307-2743
Fax Number	:

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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