MEDICARE: SHILOH COMMUNITY COUNSELING & OUTREACH CENTER

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	MFT39418	CA

General Provider Information

NPI Number	:	1538225982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHILOH COMMUNITY COUNSELING & OUTREACH CENTER

Provider Business Mailing Address
First Line	:	101 S KRAEMER BLVD
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-6105
Country	:	US
Telephone Number	:	714-223-1601
Fax Number	:	714-223-1601

Provider Business Practice Location Address
First Line	:	101 S KRAEMER BLVD
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-6105
Country	:	US
Telephone Number	:	714-223-1601
Fax Number	:	714-223-1601

Authorized Official
Title or Position	:	EXECUTIVE MANAGER
Name	:	MRS. TANYA MC PETERS
Credential	:
Telephone Number	:	714-223-1601

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	08/29/2016

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