Provider Demographics
NPI:1457489601
Name:MCNALLY, SUSAN PERKINS (MFT)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:PERKINS
Last Name:MCNALLY
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 1:2009 SICARD ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-3854
Mailing Address - Country:US
Mailing Address - Phone:530-740-3268
Mailing Address - Fax:530-755-9811
Practice Address - Street 1:2009 SICARD ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-3854
Practice Address - Country:US
Practice Address - Phone:530-740-3268
Practice Address - Fax:530-755-9811
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 17471106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457489601OtherMEDICAL
CA1457489601OtherPRIVATE