MEDICARE: MS. RUE HARRISON WHITTAKER 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
1	106H00000X	Marriage & Family Therapist	MFC38393	CA

General Provider Information

NPI Number	:	1194870550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RUE HARRISON WHITTAKER M.F.T.

Provider Business Mailing Address
First Line	:	516 OAKLAND AVE
Second Line	:	SUITE 4
City	:	OAKLAND
State	:	CA
Zip	:	94611-5429
Country	:	US
Telephone Number	:	510-409-5459
Fax Number	:	519-594-2526

Provider Business Practice Location Address
First Line	:	516 OAKLAND AVE
Second Line	:	SUITE 4
City	:	OAKLAND
State	:	CA
Zip	:	94611-5429
Country	:	US
Telephone Number	:	510-409-5459
Fax Number	:	519-594-2526

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	05/03/2016

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