Provider Demographics
NPI:1508029596
Name:FELIX, MALORIE MARTINEZ (MFT)
Entity Type:Individual
Prefix:MRS
First Name:MALORIE
Middle Name:MARTINEZ
Last Name:FELIX
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:MALORIE
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:2607 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-3415
Mailing Address - Country:US
Mailing Address - Phone:510-835-1393
Mailing Address - Fax:
Practice Address - Street 1:2607 MYRTLE ST STE HEALTH
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3415
Practice Address - Country:US
Practice Address - Phone:510-835-1393
Practice Address - Fax:510-835-2497
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 106H00000X
CA225400000X
CA88535106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7708OtherMEDICAL
CA7184OtherMEDICAL
CA7667OtherMEDICAL
CA7368OtherMEDICAL