MEDICARE: MRS. JULIA KAOHE REYNOSO LMFT

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	IMF96255	CA
2	106H00000X	Marriage & Family Therapist	LMFT119250	CA

General Provider Information

NPI Number	:	1932651502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIA KAOHE REYNOSO LMFT

Provider Business Mailing Address
First Line	:	1130 E CLARK AVE STE 150-241
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93455-5178
Country	:	US
Telephone Number	:	805-270-5602
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 E CLARK AVE STE 150-241
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93455-5178
Country	:	US
Telephone Number	:	805-270-5602
Fax Number	:

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

Provider Enumeration Date	:	10/31/2016
Last Update Date	:	02/01/2025

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