MEDICARE: MRS. KATHLEEN REGINA REAZER MS, MFT

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	MFC43176	CA

General Provider Information

NPI Number	:	1548407158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN REGINA REAZER MS, MFT

Provider Business Mailing Address
First Line	:	301 SCIENCE DRIVE
Second Line	:	#235
City	:	MOORPARK
State	:	CA
Zip	:	93021-2094
Country	:	US
Telephone Number	:	805-217-1224
Fax Number	:	805-529-1004

Provider Business Practice Location Address
First Line	:	301 SCIENCE DR
Second Line	:	#235
City	:	MOORPARK
State	:	CA
Zip	:	93021-2094
Country	:	US
Telephone Number	:	805-217-1224
Fax Number	:	805-529-1004

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

Provider Enumeration Date	:	01/20/2009
Last Update Date	:	01/20/2009

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