Provider Demographics
NPI:1609912385
Name:PLANTE, MARK DAVID (MFT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DAVID
Last Name:PLANTE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 BROADWAY STE 3
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3448
Mailing Address - Country:US
Mailing Address - Phone:650-342-8622
Mailing Address - Fax:650-342-8622
Practice Address - Street 1:1425 BROADWAY STE 3
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3448
Practice Address - Country:US
Practice Address - Phone:650-342-8622
Practice Address - Fax:650-342-8622
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34657106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist