MEDICARE: ALICIA EDA DOWELL MENTAL HEALTH WORKER

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	:	1538328091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA EDA DOWELL MENTAL HEALTH WORKER

Provider Business Mailing Address
First Line	:	2124 MAIN ST
Second Line	:	STE. 165
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-2405
Country	:	US
Telephone Number	:	714-536-0077
Fax Number	:

Provider Business Practice Location Address
First Line	:	2124 MAIN ST
Second Line	:	STE. 165
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-2405
Country	:	US
Telephone Number	:	714-536-0077
Fax Number	:

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

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	11/24/2009

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