MEDICARE: MS. ANNE C. MCCORD L.M.F.T.

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	102	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000596817	OTHER	HI	HMSA

General Provider Information

NPI Number	:	1285756718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNE C. MCCORD L.M.F.T.

Provider Business Mailing Address
First Line	:	PO BOX 1292
Second Line	:
City	:	HONOKAA
State	:	HI
Zip	:	96727-1292
Country	:	US
Telephone Number	:	808-775-9443
Fax Number	:	808-775-9443

Provider Business Practice Location Address
First Line	:	101 AUPUNI ST
Second Line	:	SUITE 108
City	:	HILO
State	:	HI
Zip	:	96720-4246
Country	:	US
Telephone Number	:	808-640-7615
Fax Number	:	808-775-9443

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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