Provider Demographics
NPI:1487893327
Name:WECK, MARY A (LMFT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:WECK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:PANDY
Other - Middle Name:
Other - Last Name:WECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:29748 RANCHO CALIFORNIA RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5286
Mailing Address - Country:US
Mailing Address - Phone:951-694-0695
Mailing Address - Fax:951-695-6215
Practice Address - Street 1:29748 RANCHO CALIFORNIA RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5286
Practice Address - Country:US
Practice Address - Phone:951-694-0695
Practice Address - Fax:951-695-6215
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 50530106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist