Provider Demographics
NPI:1407983307
Name:BRAYTON, MARY ASHLEY (MFTI)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ASHLEY
Last Name:BRAYTON
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 CHAUCER ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2202
Mailing Address - Country:US
Mailing Address - Phone:650-323-4655
Mailing Address - Fax:
Practice Address - Street 1:437 CHAUCER ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2202
Practice Address - Country:US
Practice Address - Phone:650-323-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI49016106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist