Individual
MARY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
225 CABRILLO HWY S, SUITE 200A, HALF MOON BAY, CA 94019-8200
(650) 573-3724
(650) 726-4963
Mailing address
225 CABRILLO HWY S, SUITE 200A, HALF MOON BAY, CA 94019-8200
(650) 573-3724
(650) 726-4963
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
MFC31243
CA
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
219605
CA
Other
Enumeration date
03/26/2007
Last updated
09/11/2025
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