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NPI Code Detail

MEDICARE: MS. MARY ELLEN KANZE MFT

MEDICARE: MS. MARY ELLEN KANZE 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
1106H00000XMarriage & Family TherapistMFT37852CA
2106H00000XMarriage & Family TherapistMFT000146GA

General Provider Information

NPI Number : 1215019526
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY ELLEN KANZE MFT
Provider Business Mailing Address
First Line : PO BOX 1194
Second Line :
City : PLACERVILLE
State : CA
Zip : 95667-1194
Country : US
Telephone Number : 530-621-9800
Fax Number :
Provider Business Practice Location Address
First Line : 768 PLEASANT VALLEY RD
Second Line : SUITE 304
City : DIAMOND SPRINGS
State : CA
Zip : 95619-9260
Country : US
Telephone Number : 530-621-9800
Fax Number : 530-621-9804
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2006
Last Update Date : 07/08/2007

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Directions to “ MS. MARY ELLEN KANZE MFT” Practice Location

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