Provider Demographics
NPI:1316142201
Name:VEIRS, MOLLY LOUISE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:LOUISE
Last Name:VEIRS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:LOUISE
Other - Last Name:VEIRS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:1490 N CLAREMONT BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3519
Mailing Address - Country:US
Mailing Address - Phone:909-524-1370
Mailing Address - Fax:909-575-3624
Practice Address - Street 1:1490 N CLAREMONT BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3519
Practice Address - Country:US
Practice Address - Phone:909-524-1370
Practice Address - Fax:909-575-3624
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 33950106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA870732427OtherTAX ID NUMBER