Provider Demographics
NPI:1609695857
Name:DONALDSON, MARY (LMFT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DONALDSON
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 MAIN ST STE F
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3853
Mailing Address - Country:US
Mailing Address - Phone:805-540-4743
Mailing Address - Fax:
Practice Address - Street 1:136 MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3853
Practice Address - Country:US
Practice Address - Phone:805-540-4743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152742101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health