MEDICARE: BETH CORRICK MFT

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	302R00000X	Health Maintenance Organization	MFC 46498	CA

General Provider Information

NPI Number	:	1407955016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETH CORRICK MFT

Provider Business Mailing Address
First Line	:	PO BOX 1074
Second Line	:	CARDIFF, CA 92007
City	:	CARDIFF BY THE SEA
State	:	CA
Zip	:	92007-7074
Country	:	US
Telephone Number	:	858-699-1497
Fax Number	:	858-481-8271

Provider Business Practice Location Address
First Line	:	5752 OBERLIN DR STE 203
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1749
Country	:	US
Telephone Number	:	858-699-1497
Fax Number	:	858-481-8271

Authorized Official
Title or Position	:	MARRIAGE AND FAMILY THERAPIST
Name	:	BETH CORRICK
Credential	:	LMFT
Telephone Number	:	858-699-1497

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	10/27/2010

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