MEDICARE: KRISTEN LEE PICARD

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	E1648815	CA
2	104100000X	Social Worker	32303	CA

General Provider Information

NPI Number	:	1700086766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN LEE PICARD

Provider Business Mailing Address
First Line	:	PO BOX 399
Second Line	:
City	:	CARNELIAN BAY
State	:	CA
Zip	:	96140-0399
Country	:	US
Telephone Number	:	530-546-1956
Fax Number	:	534-546-1939

Provider Business Practice Location Address
First Line	:	5225 NORTH LAKE BLVD
Second Line	:
City	:	CARNELIAN BAY
State	:	CA
Zip	:	96140-0399
Country	:	US
Telephone Number	:	530-546-1956
Fax Number	:	534-546-1939

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

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	09/27/2012

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Directions to “ KRISTEN LEE PICARD ” Practice Location

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