MEDICARE: EMILY ANDERSEN

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	139163	CA

General Provider Information

NPI Number	:	1982393401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ANDERSEN

Provider Business Mailing Address
First Line	:	16469 GERMAIN CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-1871
Country	:	US
Telephone Number	:	817-932-2140
Fax Number	:

Provider Business Practice Location Address
First Line	:	13385 HIGHLANDS PL APT 1433
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2909
Country	:	US
Telephone Number	:	817-932-2140
Fax Number	:

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

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	05/01/2023

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