Healthcare Provider Details

I. General information

NPI: 1881898146
Provider Name (Legal Business Name): MARK A GEE MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S SHEPHERD ST SUITE H
SONORA CA
95370-5038
US

IV. Provider business mailing address

20470 CHARLOTTE CT
SOULSBYVILLE CA
95372-9724
US

V. Phone/Fax

Practice location:
  • Phone: 209-768-3059
  • Fax: 209-533-7007
Mailing address:
  • Phone: 209-532-2127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC21411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: