Provider Demographics
NPI:1043367121
Name:LINDSEY, MARY THERESE (LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:THERESE
Last Name:LINDSEY
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 1:445 W FOOTHILL BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3488
Mailing Address - Country:US
Mailing Address - Phone:909-626-5313
Mailing Address - Fax:
Practice Address - Street 1:445 W FOOTHILL BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3488
Practice Address - Country:US
Practice Address - Phone:909-626-5313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2009-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31167106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist