Provider Demographics
NPI:1659486066
Name:REED, MARY COLLEEN (MFT)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:COLLEEN
Last Name:REED
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 1:2830 G ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-4446
Mailing Address - Country:US
Mailing Address - Phone:707-441-9896
Mailing Address - Fax:707-444-0405
Practice Address - Street 1:2830 G ST
Practice Address - Street 2:SUITE C
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4446
Practice Address - Country:US
Practice Address - Phone:707-441-9896
Practice Address - Fax:707-444-0405
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC17533101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health