Healthcare Provider Details

I. General information

NPI: 1194658021
Provider Name (Legal Business Name): MARIAH N MCQUEEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 5TH AVE STE 235
SAN DIEGO CA
92103-5873
US

IV. Provider business mailing address

6533 LINDA LN
SAN DIEGO CA
92120-3935
US

V. Phone/Fax

Practice location:
  • Phone: 805-407-2963
  • Fax:
Mailing address:
  • Phone: 805-407-2963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number120401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: