Provider Demographics
NPI:1295972354
Name:CADY, MARK THOMAS (MS, MFT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:THOMAS
Last Name:CADY
Suffix:
Gender:M
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 S. KIHEI RD.
Mailing Address - Street 2:SUITE O #126
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753
Mailing Address - Country:US
Mailing Address - Phone:805-630-5135
Mailing Address - Fax:808-214-6108
Practice Address - Street 1:3537 OLD CONEJO RD
Practice Address - Street 2:SUITE 113
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-2157
Practice Address - Country:US
Practice Address - Phone:805-499-8511
Practice Address - Fax:805-499-1622
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46708106H00000X
HI581106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist