MEDICARE: MS. MARY NGUYEN M.A.

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	101YM0800X	Mental Health Counselor	59977	CA

General Provider Information

NPI Number	:	1689995102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY NGUYEN M.A.

Provider Business Mailing Address
First Line	:	405 W 5TH ST STE 600
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-4536
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 W 5TH ST STE 600
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-4536
Country	:	US
Telephone Number	:	714-728-7828
Fax Number	:

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

Provider Enumeration Date	:	06/18/2010
Last Update Date	:	08/08/2012

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