Provider Demographics
NPI:1356498398
Name:HOLBROOK, MARY G (MFT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:G
Last Name:HOLBROOK
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:PO BOX 6860
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-6860
Mailing Address - Country:US
Mailing Address - Phone:707-223-6279
Mailing Address - Fax:707-443-3204
Practice Address - Street 1:837 3RD ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0511
Practice Address - Country:US
Practice Address - Phone:707-223-6279
Practice Address - Fax:707-443-3204
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT34771106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist