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General NPI Number Information
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NPI Number | 1609066505
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Entity Type | Individual
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Provider Name | MARY MOULTON MA, LMFT
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Gender | Female
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 03/22/2010
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Provider Practice Location Address
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Address Line | 370 CRENSHAW BLVD SUITE E-100
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City | TORRANCE
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State | CA
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Zip | 90503-1727
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Country | US
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Telephone | 310-787-1500
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Fax | 310-787-9713
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Provider Business Mailing Address
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Address Line | 370 S. CRENSHAW BLVD. SUITE E 100
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City | TORRANCE
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State | CA
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Zip | 90503
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Country | US
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Telephone | 310-787-1500
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Fax | 310-787-9713
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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 | MFC47363
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License Number State | CA
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