Provider Demographics
NPI:1669793824
Name:MARSHALL, TONI THERESA
Entity type:Individual
Prefix:MRS
First Name:TONI
Middle Name:THERESA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 E PALMDALE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-2029
Mailing Address - Country:US
Mailing Address - Phone:661-272-9996
Mailing Address - Fax:661-272-0438
Practice Address - Street 1:1529 E PALMDALE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-2029
Practice Address - Country:US
Practice Address - Phone:661-272-9996
Practice Address - Fax:661-272-0438
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF50798106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00007473Medicaid