Provider Demographics
NPI:1366957755
Name:BYRNE, MAUREEN ELAINE (MFT)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ELAINE
Last Name:BYRNE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:ELAINE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:27021 VIA FIESTA
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2124
Mailing Address - Country:US
Mailing Address - Phone:949-290-1739
Mailing Address - Fax:
Practice Address - Street 1:27021 VIA FIESTA
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2124
Practice Address - Country:US
Practice Address - Phone:949-290-1739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT39461106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist