Basic Information
| Provider Information | |||||||||
| NPI: | 1598895641 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RETHERFORD | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | JEANNE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46 W. GARZAS RD | ||||||||
| Address2: | |||||||||
| City: | CARMEL VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939249446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316591305 | ||||||||
| FaxNumber: | 8317962841 | ||||||||
| Practice Location | |||||||||
| Address1: | 1270 NATIVIDAD RD | ||||||||
| Address2: | ROOM 200 | ||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317554510 | ||||||||
| FaxNumber: | 8317962841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC28047 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.