MEDICARE: MR. PATRICK MCKEEFERY CAS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1528277340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK MCKEEFERY CAS

Provider Business Mailing Address
First Line	:	504 W VISTA WAY
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92083-5704
Country	:	US
Telephone Number	:	760-840-1836
Fax Number	:	760-940-1274

Provider Business Practice Location Address
First Line	:	504 W VISTA WAY
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92083-5704
Country	:	US
Telephone Number	:	760-840-1836
Fax Number	:	760-940-1274

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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