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NPI Code Detail

MEDICARE: MRS. CAREN PATRICIA RUSSELL MFT TRAINEE

MEDICARE: MRS. CAREN PATRICIA RUSSELL MFT TRAINEE
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 Therapist

General Provider Information

NPI Number : 1215165923
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CAREN PATRICIA RUSSELL MFT TRAINEE
Provider Business Mailing Address
First Line : 2000 TYLER AVE
Second Line :
City : SOUTH EL MONTE
State : CA
Zip : 91733-3543
Country : US
Telephone Number : 626-442-1400
Fax Number : 626-442-1144
Provider Business Practice Location Address
First Line : 2000 TYLER AVE
Second Line :
City : SOUTH EL MONTE
State : CA
Zip : 91733-3543
Country : US
Telephone Number : 626-442-1400
Fax Number : 626-442-1144
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2009
Last Update Date : 07/01/2009

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Directions to “ MRS. CAREN PATRICIA RUSSELL MFT TRAINEE” Practice Location

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