MEDICARE: MS. NORMA LEE MYERS LMFT

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	106H00000X	Marriage & Family Therapist	MFC35515	CA

General Provider Information

NPI Number	:	1285744466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NORMA LEE MYERS LMFT

Provider Business Mailing Address
First Line	:	2040 VINE ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94709-2034
Country	:	US
Telephone Number	:	510-849-5455
Fax Number	:	510-848-9402

Provider Business Practice Location Address
First Line	:	2040 VINE ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94709-2034
Country	:	US
Telephone Number	:	510-849-5455
Fax Number	:	510-848-9402

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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