Provider Demographics
NPI:1225063597
Name:REIGEL, MARY S (MS,LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:S
Last Name:REIGEL
Suffix:
Gender:F
Credentials:MS,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 BRADSHAW RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2615
Mailing Address - Country:US
Mailing Address - Phone:916-366-8026
Mailing Address - Fax:916-363-3327
Practice Address - Street 1:3336 BRADSHAW RD
Practice Address - Street 2:SUITE 340
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2615
Practice Address - Country:US
Practice Address - Phone:916-366-8026
Practice Address - Fax:916-363-3327
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31887106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist