Provider Demographics
NPI:1144480765
Name:STEPHENS, MARLENE MARIE (MFT)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:MARIE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1466 SANTA TERESA DRIVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565
Mailing Address - Country:US
Mailing Address - Phone:925-775-9183
Mailing Address - Fax:925-261-1210
Practice Address - Street 1:2225 BUCHANAN RD
Practice Address - Street 2:SUITE H
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509
Practice Address - Country:US
Practice Address - Phone:928-775-9183
Practice Address - Fax:925-261-1210
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 30616106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist