Provider Demographics
NPI:1053903559
Name:RANSOM, MARY (LMFT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:RANSOM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 PARK AVE # 317
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2363
Mailing Address - Country:US
Mailing Address - Phone:805-680-8988
Mailing Address - Fax:
Practice Address - Street 1:870 PARK AVE # 317
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2363
Practice Address - Country:US
Practice Address - Phone:805-680-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34668106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist