Provider Demographics
NPI:1891945630
Name:GERDES, MARCIE LOU (MFT)
Entity Type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:LOU
Last Name:GERDES
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 1:23811 WASHINGTON AVE
Mailing Address - Street 2:C110-223
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-2267
Mailing Address - Country:US
Mailing Address - Phone:951-677-1470
Mailing Address - Fax:
Practice Address - Street 1:23811 WASHINGTON AVE
Practice Address - Street 2:C110-223
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-2267
Practice Address - Country:US
Practice Address - Phone:951-677-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 36625106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist