Basic Information
| Provider Information | |||||||||
| NPI: | 1174663710 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRIESTER | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | CLAIRE | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3117 HUCKLEBERRY DR | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928823618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513586858 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9707 MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925033609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513586858 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC 38569 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.