MEDICARE: DR. PAULA SUZANNE DWELLY PH.D, MFCC

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	MM015238	CA

General Provider Information

NPI Number	:	1669588091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAULA SUZANNE DWELLY PH.D, MFCC

Provider Business Mailing Address
First Line	:	PO BOX 1047
Second Line	:
City	:	WEIMAR
State	:	CA
Zip	:	95736-1047
Country	:	US
Telephone Number	:	530-637-4116
Fax Number	:	530-637-4116

Provider Business Practice Location Address
First Line	:	21520 CANYON WAY
Second Line	:
City	:	COLFAX
State	:	CA
Zip	:	95713
Country	:	US
Telephone Number	:	530-637-4116
Fax Number	:

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/21/2007

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