Provider Demographics
NPI:1588790745
Name:CZECH, MARY (MS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CZECH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:4710 HERMANO DR
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4516
Mailing Address - Country:US
Mailing Address - Phone:818-708-8345
Mailing Address - Fax:
Practice Address - Street 1:16119 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2714
Practice Address - Country:US
Practice Address - Phone:310-542-4825
Practice Address - Fax:310-542-4552
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health