Provider Demographics
NPI:1093721912
Name:ASTLE, DAVID LAWRENCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:ASTLE
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 1:4605 BARRANCA PKWY
Mailing Address - Street 2:SUITE 101-C
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4767
Mailing Address - Country:US
Mailing Address - Phone:949-457-2735
Mailing Address - Fax:949-716-6571
Practice Address - Street 1:4605 BARRANCA PKWY
Practice Address - Street 2:STE 101C
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1726
Practice Address - Country:US
Practice Address - Phone:949-457-2735
Practice Address - Fax:949-716-6571
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15234103TB0200X, 103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP15234Medicare ID - Type Unspecified