Provider Demographics
NPI:1063180347
Name:TOMEY, MARK JOSEPH (MFT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:TOMEY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 9TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUSA
Mailing Address - State:CA
Mailing Address - Zip Code:95932-2209
Mailing Address - Country:US
Mailing Address - Phone:213-448-3670
Mailing Address - Fax:
Practice Address - Street 1:411 9TH ST
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2209
Practice Address - Country:US
Practice Address - Phone:213-448-3670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1258624106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist