MEDICARE: PATRICIA L HARVILL 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	MFC 44472	CA

General Provider Information

NPI Number	:	1972733707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA L HARVILL LMFT

Provider Business Mailing Address
First Line	:	5077 LOGAN AVE STE F
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-3000
Country	:	US
Telephone Number	:	619-262-4300
Fax Number	:	619-262-4300

Provider Business Practice Location Address
First Line	:	5077 LOGAN AVE STE F
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-3000
Country	:	US
Telephone Number	:	619-262-4300
Fax Number	:	619-262-4300

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

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	07/14/2009

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