Provider Demographics
NPI:1912337908
Name:MOUNTAIN, MARTHAELIN (EDD, MA, MFT)
Entity Type:Individual
Prefix:DR
First Name:MARTHAELIN
Middle Name:
Last Name:MOUNTAIN
Suffix:
Gender:F
Credentials:EDD, MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26465 CARMEL RANCHO BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8747
Mailing Address - Country:US
Mailing Address - Phone:831-624-5773
Mailing Address - Fax:831-626-4462
Practice Address - Street 1:26465 CARMEL RANCHO BLVD STE 3
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8747
Practice Address - Country:US
Practice Address - Phone:831-624-5773
Practice Address - Fax:831-626-4462
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44689106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist