Healthcare Provider Details

I. General information

NPI: 1083185029
Provider Name (Legal Business Name): MARYLYNN VICE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CALIFORNIA AVE STE 208
PLEASANTON CA
94566-6282
US

IV. Provider business mailing address

39 CALIFORNIA AVE STE 208
PLEASANTON CA
94566-6282
US

V. Phone/Fax

Practice location:
  • Phone: 925-337-1805
  • Fax:
Mailing address:
  • Phone: 925-337-1805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number110258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: