Provider Demographics
NPI:1316089428
Name:MARSTON, TINA (MFT)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:MARSTON
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 1:214 S BUSH ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4745
Mailing Address - Country:US
Mailing Address - Phone:707-468-8408
Mailing Address - Fax:
Practice Address - Street 1:401 W MILL ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5435
Practice Address - Country:US
Practice Address - Phone:707-462-3021
Practice Address - Fax:707-462-2268
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40866106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist