MEDICARE: MARCIELLE PFEIFER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101YA0400X	OTHER	CA	COUNSELOR ADDICTION

General Provider Information

NPI Number	:	1750571121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIELLE PFEIFER

Provider Business Mailing Address
First Line	:	610 UNION AVE APT A
Second Line	:
City	:	ORCUTT
State	:	CA
Zip	:	93455-5317
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 MORRO RD STE D
Second Line	:
City	:	ATASCADERO
State	:	CA
Zip	:	93422-4142
Country	:	US
Telephone Number	:	805-461-5212
Fax Number	:

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

Provider Enumeration Date	:	07/31/2007
Last Update Date	:	07/31/2007

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