MEDICARE: MARY WADDELL FIELD

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	:	1619480779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY WADDELL FIELD

Provider Business Mailing Address
First Line	:	617 GARDEN ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-1664
Country	:	US
Telephone Number	:	805-884-8440
Fax Number	:

Provider Business Practice Location Address
First Line	:	7167 ALAMEDA AVE
Second Line	:
City	:	GOLETA
State	:	CA
Zip	:	93117-1354
Country	:	US
Telephone Number	:	805-685-1111
Fax Number	:

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

Provider Enumeration Date	:	11/13/2017
Last Update Date	:	11/13/2017

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