Healthcare Provider Details

I. General information

NPI: 1881610772
Provider Name (Legal Business Name): MARY KATHERINE THRELKEL MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3468 MT DIABLO BLVD SUITE B201
LAFAYETTE CA
94549-3957
US

IV. Provider business mailing address

3468 MT DIABLO BLVD SUITE B201
LAFAYETTE CA
94549-3957
US

V. Phone/Fax

Practice location:
  • Phone: 925-974-8144
  • Fax: 925-284-1599
Mailing address:
  • Phone: 925-974-8144
  • Fax: 925-284-1599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC40648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: