Provider Demographics
NPI:1811011299
Name:GEORGE, MARY EMILY (MFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:EMILY
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:20371 IRVINE AVE
Mailing Address - Street 2:STE A160
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-5651
Mailing Address - Country:US
Mailing Address - Phone:714-540-5010
Mailing Address - Fax:714-540-5020
Practice Address - Street 1:20371 IRVINE AVE
Practice Address - Street 2:STE A160
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-5651
Practice Address - Country:US
Practice Address - Phone:714-540-5010
Practice Address - Fax:714-540-5020
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 30366106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist