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NPI Code Detail

MEDICARE: MARIAN PENCE VASILEVICH MA, LMFT

MEDICARE: MARIAN PENCE VASILEVICH MA, 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
1106H00000XMarriage & Family Therapist27423CA

General Provider Information

NPI Number : 1407873268
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIAN PENCE VASILEVICH MA, LMFT
Provider Business Mailing Address
First Line : 720 WOOD ST
Second Line :
City : EUREKA
State : CA
Zip : 95501-4413
Country : US
Telephone Number : 707-268-2990
Fax Number :
Provider Business Practice Location Address
First Line : 720 WOOD ST
Second Line :
City : EUREKA
State : CA
Zip : 95501-4413
Country : US
Telephone Number : 707-268-3375
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 04/24/2023

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Directions to “ MARIAN PENCE VASILEVICH MA, LMFT” Practice Location

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