Provider Demographics
NPI:1538331574
Name:FELCH, MARY JANE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JANE
Last Name:FELCH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JANE
Other - Last Name:NEUBAUER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:27001 LA PAZ RD
Mailing Address - Street 2:SUITE 254
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5524
Mailing Address - Country:US
Mailing Address - Phone:949-230-0950
Mailing Address - Fax:949-829-6941
Practice Address - Street 1:27001 LA PAZ RD
Practice Address - Street 2:SUITE 254
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5524
Practice Address - Country:US
Practice Address - Phone:949-230-0950
Practice Address - Fax:949-829-6941
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36827106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist