MEDICARE: CHRISTIN FAY WEATHERBY MFT

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	106H00000X	Marriage & Family Therapist	MFC 40777	CA

General Provider Information

NPI Number	:	1669577706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIN FAY WEATHERBY MFT

Provider Business Mailing Address
First Line	:	3133 N MILLBROOK AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93703-1425
Country	:	US
Telephone Number	:	559-453-8918
Fax Number	:	559-453-3535

Provider Business Practice Location Address
First Line	:	3133 N MILLBROOK AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93703-1425
Country	:	US
Telephone Number	:	559-453-8918
Fax Number	:	559-453-3535

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/08/2007

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