Provider Demographics
NPI:1962922294
Name:MAYALL, MONICA DIANE (LMFT, CHT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:DIANE
Last Name:MAYALL
Suffix:
Gender:F
Credentials:LMFT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 PALOMA ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-4925
Mailing Address - Country:US
Mailing Address - Phone:626-222-8384
Mailing Address - Fax:
Practice Address - Street 1:2304 PALOMA ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-4925
Practice Address - Country:US
Practice Address - Phone:626-765-7974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 174400000X
CA107079106H00000X
CAH34973174400000X
CA92070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No174400000XOther Service ProvidersSpecialist
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist