Provider Demographics
NPI:1114237724
Name:GASTIL, RICHARD W (PSYD, MSW, MFT, MA)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:GASTIL
Suffix:
Gender:M
Credentials:PSYD, MSW, MFT, MA
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:WALTER
Other - Last Name:GASTIL
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:PSYD, MSW, MFT, MA
Mailing Address - Street 1:746 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-1621
Mailing Address - Country:US
Mailing Address - Phone:714-324-2210
Mailing Address - Fax:714-779-5300
Practice Address - Street 1:746 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-1621
Practice Address - Country:US
Practice Address - Phone:714-324-2210
Practice Address - Fax:714-779-5300
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27814106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist