MEDICARE: HELEN HILLIX-DI SANTO, MARRIAGE AND FAMILY THERAPI

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	MFC20114	MO

General Provider Information

NPI Number	:	1760914790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HELEN HILLIX-DI SANTO, MARRIAGE AND FAMILY THERAPI

Provider Business Mailing Address
First Line	:	3814 LAKE CIRCLE DR
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-7872
Country	:	US
Telephone Number	:	760-990-9053
Fax Number	:	760-645-3975

Provider Business Practice Location Address
First Line	:	3814 LAKE CIRCLE DR
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-7872
Country	:	US
Telephone Number	:	760-990-9053
Fax Number	:	760-645-3975

Authorized Official
Title or Position	:	OWNER
Name	:	HELEN ANN HILLIX-DI SANTO
Credential	:	MA, LMFT
Telephone Number	:	760-990-9053

Provider Enumeration Date	:	03/29/2017
Last Update Date	:	03/29/2017

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