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NPI Code Detail

MEDICARE: MONICA E DEVRIES MFTI

MEDICARE: MONICA E DEVRIES MFTI
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 CounselorMFTI 44203CA

General Provider Information

NPI Number : 1639385826
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONICA E DEVRIES MFTI
Provider Business Mailing Address
First Line : PO BOX 29
Second Line :
City : SAN JUAN BAUTISTA
State : CA
Zip : 95045-0029
Country : US
Telephone Number : 831-402-6130
Fax Number :
Provider Business Practice Location Address
First Line : 1131 SAN FELIPE RD
Second Line :
City : HOLLISTER
State : CA
Zip : 95023-2800
Country : US
Telephone Number : 831-636-4020
Fax Number : 831-636-4025
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2007
Last Update Date : 07/08/2007

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Directions to “ MONICA E DEVRIES MFTI” Practice Location

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