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General NPI Number Information
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NPI Number | 1013067412
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Entity Type | Individual
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Provider Name | MARY BRYCE RAE MFT
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 259 S RANDOLPH AVE STE. 160
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City | BREA
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State | CA
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Zip | 92821-5739
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Country | US
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Telephone | 714-990-0909
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Fax | 909-595-5701
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Provider Business Mailing Address
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Address Line | 259 S RANDOLPH AVE STE. 160
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City | BREA
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State | CA
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Zip | 92821-5739
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Country | US
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Telephone | 714-990-0909
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Fax | 909-595-5701
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC23701
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License Number State | CA
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