Provider Demographics
NPI:1427138593
Name:EASON, MARY E (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:EASON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11459 ANTICOST WAY
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5429
Mailing Address - Country:US
Mailing Address - Phone:714-348-5056
Mailing Address - Fax:
Practice Address - Street 1:305 N HARBOR BLVD
Practice Address - Street 2:STE 202
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1901
Practice Address - Country:US
Practice Address - Phone:714-879-5868
Practice Address - Fax:714-879-5858
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17190103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling