MEDICARE: MRS. SUSAN KAUR SRAN MFT TRAINEE

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1467626424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN KAUR SRAN MFT TRAINEE

Provider Business Mailing Address
First Line	:	6902 W WRENWOOD LN
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93723-4003
Country	:	US
Telephone Number	:	559-567-6442
Fax Number	:

Provider Business Practice Location Address
First Line	:	6902 W WRENWOOD LN
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93723-4003
Country	:	US
Telephone Number	:	559-567-6442
Fax Number	:

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

Provider Enumeration Date	:	04/21/2008
Last Update Date	:	04/21/2008

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