Healthcare Provider Details

I. General information

NPI: 1013607027
Provider Name (Legal Business Name): MARILYNN DE BOARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 STAFFORD WAY STE G
YUBA CITY CA
95991-3333
US

IV. Provider business mailing address

1709 RIVER RUN DR
MARYSVILLE CA
95901-8208
US

V. Phone/Fax

Practice location:
  • Phone: 530-434-6318
  • Fax:
Mailing address:
  • Phone: 530-742-9438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: