MEDICARE: RANDI MYRSETH

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	103TC1900X	Counseling Psychologist	MFT35726	CA
2	101YM0800X	Mental Health Counselor	MFT35726	CA

General Provider Information

NPI Number	:	1649731878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDI MYRSETH

Provider Business Mailing Address
First Line	:	158 BOCANA ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-5530
Country	:	US
Telephone Number	:	415-675-5810
Fax Number	:

Provider Business Practice Location Address
First Line	:	3646 24TH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-3631
Country	:	US
Telephone Number	:	415-675-5810
Fax Number	:

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

Provider Enumeration Date	:	03/29/2019
Last Update Date	:	03/29/2019

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Directions to “ RANDI MYRSETH ” Practice Location

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