Provider Demographics
NPI:1033328976
Name:SKINNER, DENNIS BARTON (MFT)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:BARTON
Last Name:SKINNER
Suffix:
Gender:M
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:PO BOX 18
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95461-0018
Mailing Address - Country:US
Mailing Address - Phone:707-994-7090
Mailing Address - Fax:707-994-7092
Practice Address - Street 1:7000B S CENTER DR
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422-8131
Practice Address - Country:US
Practice Address - Phone:707-994-7090
Practice Address - Fax:707-994-7092
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist