MEDICARE: LAURA TOLLE 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	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist	95121	CA

General Provider Information

NPI Number	:	1205181930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA TOLLE LMFT

Provider Business Mailing Address
First Line	:	940 SARATOGA AVE
Second Line	:	SUITE 104
City	:	SAN JOSE
State	:	CA
Zip	:	95129-3428
Country	:	US
Telephone Number	:	650-446-6181
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 SARATOGA AVE
Second Line	:	SUITE 104
City	:	SAN JOSE
State	:	CA
Zip	:	95129-3428
Country	:	US
Telephone Number	:	650-446-6181
Fax Number	:

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

Provider Enumeration Date	:	07/18/2012
Last Update Date	:	11/22/2016

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