Active NPI
Greggory Tyler Mayne
- Marriage & Family Therapist
- Petaluma, CA
National Provider Identifier
1851529648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 115984
- Practice address
- 5350 Old Redwood Hwy N
Suite 600
Petaluma, CA 94954 - Phone
- (707) 565-4420
- NPI assigned
- Jun 30, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 115984 | CA | Primary |
Addresses
Primary practice location
5350 Old Redwood Hwy N
Suite 600
Petaluma, CA 94954
Mailing address
5350 Old Redwood Hwy N
Suite 600
Petaluma, CA 94954
Phone (707) 565-4420
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 12, 2024 through Nov 12, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1767744000000",
"number": "1851529648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5350 OLD REDWOOD HWY N",
"address_2": "SUITE 600",
"city": "PETALUMA",
"state": "CA",
"postal_code": "94954",
"telephone_number": "707-565-4420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5350 OLD REDWOOD HWY N",
"address_2": "SUITE 600",
"city": "PETALUMA",
"state": "CA",
"postal_code": "94954",
"telephone_number": "707-565-4420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYNE",
"first_name": "GREGGORY",
"middle_name": "TYLER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-30",
"last_updated": "2026-01-07",
"certification_date": "2026-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "115984",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.