MEDICARE: MISS COLLEEN ANN SEBASTIAN MC, LMFT

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	MFC 43194	CA
2	106H00000X	Marriage & Family Therapist	LMFT43194	CA

General Provider Information

NPI Number	:	1083771380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS COLLEEN ANN SEBASTIAN MC, LMFT

Provider Business Mailing Address
First Line	:	PO BOX 597
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93448-0597
Country	:	US
Telephone Number	:	805-779-0903
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 E GRAND AVE STE 115E
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-2461
Country	:	US
Telephone Number	:	805-779-0903
Fax Number	:

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/22/2019

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