Provider Demographics
NPI:1235101577
Name:XANTHOS, MARIA S (MFT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:S
Last Name:XANTHOS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:S
Other - Last Name:XANTHOS HILDING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5255
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92838-0255
Mailing Address - Country:US
Mailing Address - Phone:714-526-0758
Mailing Address - Fax:714-680-3315
Practice Address - Street 1:440 E COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832
Practice Address - Country:US
Practice Address - Phone:714-526-0758
Practice Address - Fax:714-680-3315
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMSC29896106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist