MEDICARE: JASON EDWARD SEALS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	106H00000X	Marriage & Family Therapist	IMF62214	CA

General Provider Information

NPI Number	:	1518167154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON EDWARD SEALS

Provider Business Mailing Address
First Line	:	870 S 45TH ST APT 5
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-4454
Country	:	US
Telephone Number	:	510-277-2008
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 MYRTLE ST
Second Line	:	SUITE 102
City	:	OAKLAND
State	:	CA
Zip	:	94607-2525
Country	:	US
Telephone Number	:	510-663-3880
Fax Number	:

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

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	01/31/2011

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Directions to “ JASON EDWARD SEALS ” Practice Location

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