Provider Demographics
NPI:1003956111
Name:ROY, DAVID E (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:ROY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5475 N FRESNO ST STE 109
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8333
Mailing Address - Country:US
Mailing Address - Phone:559-435-7835
Mailing Address - Fax:559-435-6314
Practice Address - Street 1:5475 N FRESNO ST STE 109
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8333
Practice Address - Country:US
Practice Address - Phone:559-435-7835
Practice Address - Fax:559-435-6314
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
CA8793106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist