MEDICARE: MS. MOLLY ROSE REED 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	LMFT90056	CA

General Provider Information

NPI Number	:	1386094316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MOLLY ROSE REED LMFT

Provider Business Mailing Address
First Line	:	725 FARMERS LN
Second Line	:	SUITE 16
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-6710
Country	:	US
Telephone Number	:	707-971-0216
Fax Number	:

Provider Business Practice Location Address
First Line	:	2635 CLEVELAND AVE
Second Line	:	SUITE 2
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2989
Country	:	US
Telephone Number	:	707-971-0216
Fax Number	:

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

Provider Enumeration Date	:	06/21/2016
Last Update Date	:	04/05/2017

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