MEDICARE: BETSY JOST L.M.F.T.

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	MFC42432	CA

General Provider Information

NPI Number	:	1457405011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETSY JOST L.M.F.T.

Provider Business Mailing Address
First Line	:	1500 W SHAW AVE
Second Line	:	SUITE #102
City	:	FRESNO
State	:	CA
Zip	:	93711-3501
Country	:	US
Telephone Number	:	559-226-1128
Fax Number	:	559-226-1128

Provider Business Practice Location Address
First Line	:	1500 W SHAW AVE
Second Line	:	SUITE #102
City	:	FRESNO
State	:	CA
Zip	:	93711-3501
Country	:	US
Telephone Number	:	559-226-1128
Fax Number	:	559-226-1128

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	02/21/2013

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