Provider Demographics
NPI:1245653526
Name:TRAIL, MARY ELIZABETH (MFT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:TRAIL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MARY BETH
Other - Middle Name:
Other - Last Name:TRAIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:2370 MARKET ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1521
Mailing Address - Country:US
Mailing Address - Phone:415-522-7347
Mailing Address - Fax:
Practice Address - Street 1:2370 MARKET ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1521
Practice Address - Country:US
Practice Address - Phone:415-522-7347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53864106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist