Provider Demographics
NPI:1891938635
Name:MCRAE, MARY ELLEN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARY ELLEN
Middle Name:
Last Name:MCRAE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MARY ELLEN
Other - Middle Name:
Other - Last Name:CLAYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-0099
Mailing Address - Country:US
Mailing Address - Phone:209-966-2000
Mailing Address - Fax:209-966-8251
Practice Address - Street 1:5078 BULLION STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338
Practice Address - Country:US
Practice Address - Phone:209-742-3498
Practice Address - Fax:209-966-3925
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA52655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health