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MRS. MARY M FOSSUM
NPI 1245582121
Marriage & Family Therapist in Sacramento, CA

Active since October 03, 2012Opted out of Medicare · through Jan 25, 2028
1722 PROFESSIONAL DR, SACRAMENTO, CA 95825(916) 716-0095(916) 973-9158 Get Directions Write a Review

NPPES record last updated: October 3, 2012. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Mrs. Mary M Fossum NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. MARY M FOSSUM (NPI 1245582121) is an individual marriage & family therapist in Sacramento, California, licensed in California (MFC40137) and active in the NPI registry since October 2012. She has opted out of Medicare through January 25, 2028.

NPPES Registry Identity

NPI1245582121
Entity TypeIndividualFemale
Primary Taxonomy106H00000X
Provider Legal NameMRS. MARY M FOSSUM
Location Address1722 PROFESSIONAL DRSacramento, CA 95825-2105
Mailing Address1722 Professional DrSacramento, CA 95825-2105 · (916) 716-0095 · Fax (916) 973-9158
Phone(916) 716-0095
Fax(916) 973-9158
Sole ProprietorYes
Enumeration DateOctober 3, 2012
✔ NPI 1245582121 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers
Taxonomy Code106H00000X
License✔ Licensed in CA · MFC40137
Definition
A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.
1722 PROFESSIONAL DR, Sacramento, CA 95825
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Other Names 1

Professional Name (2)Mrs. Elly M Fossum Ba., Ms

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Mrs. Mary M Fossum has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 25, 2024 through January 25, 2028.

Opt-Out Effective DateJanuary 25, 2024
Opt-Out In Effect ThroughJanuary 25, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. CHERYL ELIZABETH MCVEY MFT
Marriage & Family Therapist
1722 PROFESSIONAL DR
SACRAMENTO, CA 95825
Sacramento County (916) 417-2192
PAULA LYNN WHITTINGHAM L.C.S.W.
Social Worker (Clinical)
1722 PROFESSIONAL DR
SACRAMENTO, CA 95825
Sacramento County (916) 801-2271

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Fossum's NPI number?

The NPI number for Mary Fossum is 1245582121. It was assigned to this individual provider in the NPPES registry on October 3, 2012. The provider is also known as Mrs. Elly M Fossum Ba., Ms.

Where is Mary Fossum located?

Mary Fossum practices at 1722 Professional Dr, Sacramento, CA 95825. The listed phone number is (916) 716-0095.

What is Mary Fossum's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Is Mary Fossum enrolled in Medicare?

No. Mary Fossum has opted out of Medicare through January 25, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Mary Fossum was last updated on October 3, 2012. NPI Profile syncs with the weekly NPPES data releases published by CMS.