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NPI Code Detail

MEDICARE: MR. STEVE RICHARD WILBUR M.S. MFT

MEDICARE: MR. STEVE RICHARD WILBUR M.S. 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
1106H00000XMarriage & Family Therapist40659CA

General Provider Information

NPI Number : 1700046604
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STEVE RICHARD WILBUR M.S. MFT
Provider Business Mailing Address
First Line : 1465 LINCOLN AVE
Second Line :
City : SAN RAFAEL
State : CA
Zip : 94901-2028
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1465 LINCOLN AVE
Second Line :
City : SAN RAFAEL
State : CA
Zip : 94901-2028
Country : US
Telephone Number : 415-328-1132
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2008
Last Update Date : 06/13/2008

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