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NPI Code Detail

MEDICARE: MRS. ROXANNE LEA THOMAS BAXTER LMFT, CTS

MEDICARE:  MRS. ROXANNE LEA THOMAS BAXTER  LMFT, CTS
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
1106H00000XMarriage & Family TherapistMFC 39524CA

General Provider Information

NPI Number : 1366540882
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ROXANNE LEA THOMAS BAXTER LMFT, CTS
Provider Business Mailing Address
First Line : 2423 CAMINO DEL RIO S
Second Line : SUITE 103
City : SAN DIEGO
State : CA
Zip : 92108-3702
Country : US
Telephone Number : 619-933-6256
Fax Number :
Provider Business Practice Location Address
First Line : 2423 CAMINO DEL RIO S
Second Line : SUITE 103
City : SAN DIEGO
State : CA
Zip : 92108-3702
Country : US
Telephone Number : 619-933-6256
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. ROXANNE LEA THOMAS BAXTER LMFT, CTS” Practice Location

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