MEDICARE: MARK TROEDSON 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	MFC37963	CA

General Provider Information

NPI Number	:	1689792186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK TROEDSON MFT

Provider Business Mailing Address
First Line	:	21445 CENTRE POINTE PKWY
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91350-2684
Country	:	US
Telephone Number	:	661-259-0033
Fax Number	:

Provider Business Practice Location Address
First Line	:	21445 CENTRE POINTE PKWY
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91350-2684
Country	:	US
Telephone Number	:	661-259-0033
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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