MEDICARE: SHIRLEY AILSWORTH

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		CA
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1215215173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY AILSWORTH

Provider Business Mailing Address
First Line	:	PO BOX 880682
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94188-0682
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 MISSION ST FL 2
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-2647
Country	:	US
Telephone Number	:	682-217-7762
Fax Number	:

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

Provider Enumeration Date	:	07/26/2011
Last Update Date	:	02/06/2024

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Directions to “ SHIRLEY AILSWORTH ” Practice Location

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