Provider Demographics
NPI:1093817181
Name:CLARY, ANNE LOUISE (MFT)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:LOUISE
Last Name:CLARY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 S ELENA AVE
Mailing Address - Street 2:#205
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5703
Mailing Address - Country:US
Mailing Address - Phone:310-373-9229
Mailing Address - Fax:310-545-0940
Practice Address - Street 1:1840 S ELENA AVE
Practice Address - Street 2:#205
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5703
Practice Address - Country:US
Practice Address - Phone:310-373-9229
Practice Address - Fax:310-545-0940
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAME23879106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAME23879OtherMFT LICENSE