Provider Demographics
NPI:1558839605
Name:VAN RIPER, MARY W (LMFT, LPCC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:W
Last Name:VAN RIPER
Suffix:
Gender:F
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 FREMONT AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5602
Mailing Address - Country:US
Mailing Address - Phone:650-935-5715
Mailing Address - Fax:
Practice Address - Street 1:851 FREMONT AVE STE 106
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5602
Practice Address - Country:US
Practice Address - Phone:650-935-5715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9935101YP2500X
CA100837106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9935OtherBBS PCC LICENSE NUMBER
CA100837OtherBBS MFT LICENSE NUMBER