Healthcare Provider Details

I. General information

NPI: 1598895641
Provider Name (Legal Business Name): MARIE JEANNE RETHERFORD MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 NATIVIDAD RD ROOM 200
SALINAS CA
93906
US

IV. Provider business mailing address

46 W. GARZAS RD
CARMEL VALLEY CA
93924-9446
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4510
  • Fax: 831-796-2841
Mailing address:
  • Phone: 831-659-1305
  • Fax: 831-796-2841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC28047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: