MEDICARE: ROSE E HOLLOW HORN BEAR M.A., MFT INTERN

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	64494	CA

General Provider Information

NPI Number	:	1457431660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE E HOLLOW HORN BEAR M.A., MFT INTERN

Provider Business Mailing Address
First Line	:	PO BOX 1579
Second Line	:
City	:	SHINGLE SPRINGS
State	:	CA
Zip	:	95682-1579
Country	:	US
Telephone Number	:	530-672-8059
Fax Number	:	530-672-8057

Provider Business Practice Location Address
First Line	:	4140 MOTHER LODE DR
Second Line	:	104
City	:	SHINGLE SPRINGS
State	:	CA
Zip	:	95682-8038
Country	:	US
Telephone Number	:	530-672-8059
Fax Number	:	530-672-8057

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	03/16/2011

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Directions to “ ROSE E HOLLOW HORN BEAR M.A., MFT INTERN” Practice Location

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