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NPI Code Detail

MEDICARE: MR. JEDIDIAH PURSES AMFT

MEDICARE: MR. JEDIDIAH PURSES AMFT
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
1101YM0800XMental Health Counselor111405CA

General Provider Information

NPI Number : 1609415207
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEDIDIAH PURSES AMFT
Provider Business Mailing Address
First Line : 300 TAMAL PLZ STE 220
Second Line :
City : CORTE MADERA
State : CA
Zip : 94925-1136
Country : US
Telephone Number : 415-459-5206
Fax Number :
Provider Business Practice Location Address
First Line : 300 TAMAL PLZ STE 220
Second Line :
City : CORTE MADERA
State : CA
Zip : 94925-1136
Country : US
Telephone Number : 415-459-5206
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2019
Last Update Date : 12/30/2019

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