Provider Demographics
NPI:1245522812
Name:NAMBU, MARY LEE (MA, LMFT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LEE
Last Name:NAMBU
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E MEDA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2607
Mailing Address - Country:US
Mailing Address - Phone:626-429-6550
Mailing Address - Fax:
Practice Address - Street 1:150 E MEDA AVE STE 110
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-2607
Practice Address - Country:US
Practice Address - Phone:626-429-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT97269106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist