MEDICARE: MR. JOHN CUNNINGHAM 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	MFT ME23888	CA

General Provider Information

NPI Number	:	1548355969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN CUNNINGHAM LMFT

Provider Business Mailing Address
First Line	:	705 PINE ST.
Second Line	:
City	:	MT SHASTA
State	:	CA
Zip	:	96067
Country	:	US
Telephone Number	:	530-926-5888
Fax Number	:	530-926-5888

Provider Business Practice Location Address
First Line	:	705 PINE ST.
Second Line	:
City	:	MT SHASTA
State	:	CA
Zip	:	96067
Country	:	US
Telephone Number	:	530-926-5888
Fax Number	:	530-926-5888

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. JOHN CUNNINGHAM LMFT” Practice Location

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