MEDICARE: ALTHEA EARLE

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	85395	CA

General Provider Information

NPI Number	:	1407236433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALTHEA EARLE

Provider Business Mailing Address
First Line	:	5957 SHATTUCK
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5957 SHATTUCK AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-1434
Country	:	US
Telephone Number	:	415-801-4717
Fax Number	:

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

Provider Enumeration Date	:	06/04/2015
Last Update Date	:	06/04/2015

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Directions to “ ALTHEA EARLE ” Practice Location

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