Provider Demographics
NPI:1487674636
Name:PECK, MARIANNE (MFT)
Entity type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:
Last Name:PECK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 STANDIFORD AVE
Mailing Address - Street 2:SUITE B 2
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0982
Mailing Address - Country:US
Mailing Address - Phone:209-631-7099
Mailing Address - Fax:209-522-5134
Practice Address - Street 1:1101 STANDIFORD AVE
Practice Address - Street 2:SUITE B 2
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0982
Practice Address - Country:US
Practice Address - Phone:209-631-7099
Practice Address - Fax:209-522-5134
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC17999101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770044810OtherT.I.D.