Provider Demographics
NPI:1407889686
Name:PEDERSEN, MARY JO (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JO
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2234
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93457-2234
Mailing Address - Country:US
Mailing Address - Phone:805-264-2584
Mailing Address - Fax:805-937-0877
Practice Address - Street 1:2355 LAKE MARIE DRIVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455
Practice Address - Country:US
Practice Address - Phone:805-934-5088
Practice Address - Fax:805-937-0877
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38335101YM0800X
CALMFT38335101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health