MEDICARE: MARA L HUNDRIESER MA

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

General Provider Information

NPI Number	:	1790555779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARA L HUNDRIESER MA

Provider Business Mailing Address
First Line	:	372 E EMERSON ST
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-3708
Country	:	US
Telephone Number	:	619-454-9060
Fax Number	:

Provider Business Practice Location Address
First Line	:	6232 N PULASKI RD STE 400
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5133
Country	:	US
Telephone Number	:	312-725-3093
Fax Number	:

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

Provider Enumeration Date	:	01/02/2024
Last Update Date	:	01/02/2024

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