Provider Demographics
NPI:1619078284
Name:MESTEMACHER, ALICE MARIE (LICENSED MARRIGE FAM)
Entity type:Individual
Prefix:MS
First Name:ALICE
Middle Name:MARIE
Last Name:MESTEMACHER
Suffix:
Gender:F
Credentials:LICENSED MARRIGE FAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 A GREEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-5922
Mailing Address - Country:US
Mailing Address - Phone:831-761-0668
Mailing Address - Fax:
Practice Address - Street 1:256 A GREEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-5922
Practice Address - Country:US
Practice Address - Phone:831-761-0668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18468106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist