MEDICARE: WESLEY-MARTIN ERVIN

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
2	106H00000X	Marriage & Family Therapist	144361	CA

General Provider Information

NPI Number	:	1992461198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WESLEY-MARTIN ERVIN

Provider Business Mailing Address
First Line	:	920 REDWOOD LN
Second Line	:
City	:	LEMOORE
State	:	CA
Zip	:	93245-3746
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 REDWOOD LN
Second Line	:
City	:	LEMOORE
State	:	CA
Zip	:	93245-3746
Country	:	US
Telephone Number	:	559-904-0977
Fax Number	:

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

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	02/12/2024

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Directions to “ WESLEY-MARTIN ERVIN ” Practice Location

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