Provider Demographics
NPI:1801015714
Name:CURTIS, MARJORIE AGNES (MFT, RN)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:AGNES
Last Name:CURTIS
Suffix:
Gender:F
Credentials:MFT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45355 MESA CV
Mailing Address - Street 2:
Mailing Address - City:INDIAN WELLS
Mailing Address - State:CA
Mailing Address - Zip Code:92210-7140
Mailing Address - Country:US
Mailing Address - Phone:760-341-2723
Mailing Address - Fax:760-341-8574
Practice Address - Street 1:45355 MESA CV
Practice Address - Street 2:
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210-7140
Practice Address - Country:US
Practice Address - Phone:760-341-2723
Practice Address - Fax:760-341-8574
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41203106H00000X
CA222594163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered163W00000XNursing Service ProvidersRegistered Nurse