Provider Demographics
NPI:1992837181
Name:HUNTER, MARIDEE TRICE (PHD)
Entity Type:Individual
Prefix:
First Name:MARIDEE
Middle Name:TRICE
Last Name:HUNTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80285
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-0285
Mailing Address - Country:US
Mailing Address - Phone:949-689-4389
Mailing Address - Fax:949-481-4914
Practice Address - Street 1:30211 AVENIDA DE LAS BANDERA
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2147
Practice Address - Country:US
Practice Address - Phone:949-689-4389
Practice Address - Fax:949-481-4914
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16894103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist