MEDICARE: MS. LAUREL DRAKE FRASER LMFT

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	MFC35810	CA

General Provider Information

NPI Number	:	1538233580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREL DRAKE FRASER LMFT

Provider Business Mailing Address
First Line	:	1720 E LOS ANGELES AVE
Second Line	:	SUITE 236
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-2033
Country	:	US
Telephone Number	:	805-527-2237
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 E LOS ANGELES AVE
Second Line	:	SUITE 236
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-2033
Country	:	US
Telephone Number	:	805-527-2237
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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