Provider Demographics
NPI:1871668897
Name:LOAR, MARY GRACE (MFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:GRACE
Last Name:LOAR
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 1:41591 EAST FLORIDA AVENUE, SUITE D
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-4883
Mailing Address - Country:US
Mailing Address - Phone:951-206-4559
Mailing Address - Fax:951-444-6153
Practice Address - Street 1:41591 EAST FLORIDA AVENUE, SUITE D
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-4883
Practice Address - Country:US
Practice Address - Phone:951-206-4559
Practice Address - Fax:951-444-6153
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45331106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist