MEDICARE: PAUL PRIBUSS PAUL PRIBUSS

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	101YP2500X	Professional Counselor	MFT359111	CA

General Provider Information

NPI Number	:	1225062227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL PRIBUSS PAUL PRIBUSS

Provider Business Mailing Address
First Line	:	834 MISSION AVE
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-3209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	834 MISSION AVE
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-3209
Country	:	US
Telephone Number	:	415-686-2260
Fax Number	:

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	06/13/2014

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