Provider Demographics
NPI:1154673275
Name:REILEY, MARNEE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MARNEE
Middle Name:
Last Name:REILEY
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17682 MITCHELL N
Mailing Address - Street 2:SUITE 104
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6046
Mailing Address - Country:US
Mailing Address - Phone:949-648-7991
Mailing Address - Fax:
Practice Address - Street 1:17682 MITCHELL N
Practice Address - Street 2:SUITE 104
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6046
Practice Address - Country:US
Practice Address - Phone:949-648-7991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83021106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist