MEDICARE: TROY RICE MA MFTI

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	171M00000X	Case Manager/Care Coordinator		CA
3	106H00000X	Marriage & Family Therapist	63491	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1669559878	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1396873154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TROY RICE MA MFTI

Provider Business Mailing Address
First Line	:	1617 E SAGINAW WAY
Second Line	:	#102
City	:	FRESNO
State	:	CA
Zip	:	93704-4458
Country	:	US
Telephone Number	:	559-274-0299
Fax Number	:	559-244-0328

Provider Business Practice Location Address
First Line	:	1617 E SAGINAW WAY
Second Line	:	#102
City	:	FRESNO
State	:	CA
Zip	:	93704-4458
Country	:	US
Telephone Number	:	559-274-0299
Fax Number	:	559-244-0328

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	05/02/2012

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