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NPI Code Detail

MEDICARE: HEDLEY VANKUCH AMFT

MEDICARE: HEDLEY VANKUCH 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
1106H00000XMarriage & Family Therapist143695CA

General Provider Information

NPI Number : 1639901788
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEDLEY VANKUCH AMFT
Provider Business Mailing Address
First Line : 35811 CHALET CT
Second Line :
City : MURRIETA
State : CA
Zip : 92563-1840
Country : US
Telephone Number : 805-865-5214
Fax Number :
Provider Business Practice Location Address
First Line : 24195 JUANITA DR
Second Line :
City : CANYON LAKE
State : CA
Zip : 92587-9294
Country : US
Telephone Number : 951-356-9613
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2024
Last Update Date : 08/16/2024

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Directions to “ HEDLEY VANKUCH AMFT” Practice Location

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