MEDICARE: MISTY LEE BATCH 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	38556	CA

General Provider Information

NPI Number	:	1295978575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTY LEE BATCH LMFT

Provider Business Mailing Address
First Line	:	1585 THE ALAMEDA STE 202
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2310
Country	:	US
Telephone Number	:	408-504-1559
Fax Number	:

Provider Business Practice Location Address
First Line	:	1585 THE ALAMEDA STE 202
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2310
Country	:	US
Telephone Number	:	408-504-1559
Fax Number	:

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

Provider Enumeration Date	:	04/15/2009
Last Update Date	:	04/15/2009

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