MEDICARE: MS. KAREN WACHTEL MFT-I, CATC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	RAS W0507071356	CA
2	106H00000X	Marriage & Family Therapist	76288	CA

General Provider Information

NPI Number	:	1225095532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN WACHTEL MFT-I, CATC

Provider Business Mailing Address
First Line	:	PO BOX 5084
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-0084
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3440 VIKING DR
Second Line	:	#114
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2844
Country	:	US
Telephone Number	:	916-364-8395
Fax Number	:

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	11/30/2016

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