Healthcare Provider Details

I. General information

NPI: 1053799809
Provider Name (Legal Business Name): MARYKE VAN ZYL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARYKE HARRISON

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 CLEMENT ST # 116C
SAN FRANCISCO CA
94121-1563
US

IV. Provider business mailing address

4150 CLEMENT ST # 116C
SAN FRANCISCO CA
94121-1563
US

V. Phone/Fax

Practice location:
  • Phone: 415-758-8721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20043430A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: