MEDICARE: KARLA AMANDA BROWN 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	103907	CA

General Provider Information

NPI Number	:	1538509047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLA AMANDA BROWN LMFT

Provider Business Mailing Address
First Line	:	3705 HAVEN AVE STE 125
Second Line	:
City	:	MENLO PARK
State	:	CA
Zip	:	94025-1011
Country	:	US
Telephone Number	:	650-667-0117
Fax Number	:	800-858-5809

Provider Business Practice Location Address
First Line	:	3705 HAVEN AVE STE 125
Second Line	:
City	:	MENLO PARK
State	:	CA
Zip	:	94025-1011
Country	:	US
Telephone Number	:	650-667-0117
Fax Number	:	800-858-5809

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

Provider Enumeration Date	:	06/28/2013
Last Update Date	:	12/06/2019

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